430754912-1-5-2022-52-CC-SDOO-CADSES-20220105124913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430754912
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:49:25 PM

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: 3	DATE:	01/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mahjabin Chekeni Ahmad Chekeni		TIME COMPLETED:	12:45 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	On 01/05/2022 at approximately 8:30am Licensing Program Analyst (LPA) Sabina Dodoo met with licensees Mahjabin Chekeni and Ahmad Chekeni for an UNANNOUCED ANNUAL REQUIRED INSPECTION (including expired Probationary License of 3 years) for a Family Child Care Home. Present for the inspection were licensees and three children. The total children enrolled are 5 and the census was 3 at the time of the inspection. The Family Child Care Home is within ratio. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 7:30am to 5:00pm. The Family Child Care Home is a two-story home with four bedrooms (one bedroom converted into an office), three bathrooms, one half bathroom in living the room area, one kitchen, one living room, and a dining area. There is a cottage house located in the backyard. The cottage house has one living room converted into a playroom, two bedrooms with full bath (one room is reading room, and other room is baby room). There are arts and craft materials, manipulation play area, and building blocks for children to play with. The backyard has a wooden play structure with a green slide tube. There are mats around the play structure that helps to absorb falls. There sleeping cots and see through cribs with a changing table in the baby room area. The entrance of the Family Day Care Home is the gate leading to the paved front yard where a side gate can be accessed to walk to the cottage house in the back. The parents communicate with licensee by phone when dropping or picking up the children. Throughout the day the licensee updates parents with activities through text messages and sending photos. LPA (Dodoo) observed the activity room to be neat with proper ventilation and materials equipped to care for the children. LPA (Dodoo) observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). The licensee provides lunch and snacks for the children.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: 01/05/2022

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
26
27
28
29
30
31
32

Licensee also provides filtered water throughout the day. There are cubbies with the children’s names on them. There is a fireplace that is covered. There are no bodies of water on the premises. There is a water fountain in the front yard that is empty. There are no firearms on premises. All chemicals are kept out of reach of the children.

The OFF-LIMIT AREAS are the two bedrooms downstairs, the two full bathrooms downstairs, laundry room and the master suite with the office located upstairs.

The ON-LIMIT AREAS the whole cottage house which consist: (playroom, baby room, bathroom, office reading room), kitchen in the main house, the living room, the half bathroom, and the backyard.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The Family Child Care Home has two fully charged fire extinguisher 3A-10- 40 BC, a working smoke detector, working carbon monoxide, telephone and fully stocked first aid kits. The furniture around the playroom area all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children.The licensee has completed the Health and Safety training and CPR/First Aid is current. The licensees are following the immunization laws and have completed the mandated reporter training. The Licensees conducted and documented the fire and disaster drills twice a year and the last conducted drill was in October of 2021. All required forms are posted and visible for public view.

At 10:30am LPA (Sabina Dodoo) reviewed 3 children’s files and both licensee files and documented them on LIC 857 and LIC 859. An updated roster was viewed by LPA and a copy was obtained. The staff interview was completed with Licensee Mahjabin Chekeni.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 01/05/2022

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children currently. If any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over working in Child Care Center, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: 01/05/2022

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
26
27
28
29
30
31
32

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Mahjabin Chekeni) at 12pm. This report shall remain on file for the next 3 years.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4