430754912-4-17-2024-52-CC-MOTI-D4ER5Z-20240417124357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430754912
Report Date: 04/17/2024
Date Signed: 04/17/2024 12:44:15 PM

Document Has Been Signed on 04/17/2024 12:44 PM - It Cannot Be Edited

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:	04/17/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Mahjabin and 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	Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on today's date, 04/17/2024, to conduct a REQUIRED - ANNUAL REQUIRED INSPECTION. LPA was met by Licensees, Mahjabin and Ahmad Chekeni. Also present during today's visit were 6 children (3 preschoolers and 3 infant aged children). LPA conducted a health and safety inspection inside and outside. Facility's current hours of operation are: Monday through Friday 7:30AM - 5:30PM. The Family Child Care Home is a two story, single family house with a cottage house in the backyard which is used for day care purposes. Outdoor play area is fenced and contains age appropriate play materials. There is a play structure which has mats to absorb a fall. The home has heating and ventilation for safety and comfort. The home has a fully charged fire extinguisher. Facility has a working smoke detector and working carbon monoxide detector, and working telephone. Per licensee, there are no firearms in the home. All REQUIRED forms are posted and visible for public review. To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

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: 04/17/2024

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When 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: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Mahjabin Chekeni, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days. No citations found on today's date.
Exit interview conducted and report was reviewed with the licensee Mahjabin Chekeni.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC809 (FAS) - (06/04)

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