430754912-2-12-2020-52-CC-MOTI-BLQUHR-20200212143621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430754912
Report Date: 02/12/2020
Date Signed: 02/12/2020 02:36:28 PM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHEKENI, MAHJABIN AND AHMAD		FACILITY NUMBER:	430754912
ADMINISTRATOR:	CHEKENI, MAHJABIN & AHMAD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 326-2695
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	14	CENSUS: 6	DATE:	02/12/2020
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Mahjabin & Ahmad Chekeni		TIME COMPLETED:	02:54 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Melanie Otsuji and Mayla Mendoza conducted an unannounced, Annual Required, inspection on today's date 2/12/2020. LPAs were met by Licensee's Mahjabin & Ahmad Chekeni. There were 6 day care children (2 infants and 4 preschoolers) present. Days and hours of operation are Monday through Friday 7:30AM to 5:30PM. Licensee's CPR and first aid card is current and expires on 02/16/2021. LPAs toured the indoor and outdoor areas of the home and day care rooms. Licensee states that fire drills are conducted at minimum every six months when children are in care. Last drill was conducted on 01/2020. The roster is current and up to date. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home and day care area is clean and safe for the day care children. LPAs did not observe any wall heaters inside the home or day care area. There are no stairs in the day care area. LPAs observed a fully charged 2A10BC fire extinguisher located outside in the play area. There is a working smoke detector and carbon monoxide detector. The backyard is fenced. There are no bodies of water. The Licensee states that she does not have any weapons in the home. All poisons, detergents, cleaning supplies, medications, and other similar items are inaccessible to children. Child records were reviewed and LPAs found the files to be in order. Individual Medical Services (IMS) was discussed. This facility does not currently have any children in care requiring IMS. Anytime IMS plan of operation changes, Licensee's will provide an updated IMS plan. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEKENI, MAHJABIN AND AHMAD	FACILITY NUMBER: 430754912
	VISIT DATE: 02/12/2020

NARRATIVE

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LPAs reviewed facility file. Immunizations and current mandated reporter certificates for Licensees were reviewed. Licensees were informed that when current mandated reporter certificates on 1/12/2021, licensee's are to take both general and child care provider training located at mandatedreporterca.com.

No deficiencies were issued during the inspection. Exit interview was conducted with the Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE DAY CARE AREA, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020

LIC809 (FAS) - (06/04)

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