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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004619
Report Date: 12/23/2020
Date Signed: 12/23/2020 10:40:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BETERGESHFA, ZARIMA M.FACILITY NUMBER:
414004619
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
12/23/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Zarima BetergeshfaTIME COMPLETED:
12:00 PM
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Due to the current 'Shelter in Place' order in effect, Licensing Program Analyst (LPA), Harsimran kaur spoke with Licensee, Zarima Betergeshfa via tele-video call. Licensee has requested to increase capacity from small family child care home to a large family child care home (FCCH). There are 4 day care children present. All adults living/working with the children in the home have criminal record clearance. Daycare area is: 2 bedrooms, bathroom and backyard. Backyard is properly fenced and have play house, tables and chairs for children. OFF LIMIT AREA - Upstairs bedrooms and kitchen.

There is no change in the day care settings. Facility has a approved fire clearance. Facility has a working smoke detector, a carbon monoxide detector and a one working telephone. A 2A10BC fire extinguisher is fully charged. Licensee's CPR/First aid is current. Per licensee, there is no firearms or no weapons in the home. Licensee's has current immunization on the file. There are sufficient, age appropriated toys and children's equipment in the day care area. Staff-children ratio were discussed with Licensee for a Large Family Child Care Home (FCCH).
Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption. pursuant to Health and Safety code 1596.7995 and 1597.662.

*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.

Large Family Child Care License is recommended and will be effective as of today, 12/23/2020

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available Monday - Friday, 8:00am - 5:00pm. (650) 266-8800. Website for Forms and Regulations: www.cdss.ca.gov.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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