434401704-6-29-2021-52-CC-JSAR-C4FR48-20210629124107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434401704
Report Date: 06/29/2021
Date Signed: 06/29/2021 12:41:13 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:	FATHI, SETARE		FACILITY NUMBER:	434401704
ADMINISTRATOR:	FATHI, SETARE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 964-8677
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94024
CAPACITY:	14	CENSUS: 6	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Setare Fathi		TIME COMPLETED:	01:00 PM

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On 06/28/21 at 09:15 AM, Licensing Program Analyst (LPA) James Sampair, conducted an Annual Random inspection of Licensee Setare Fathi's Family Child Care Home. Also living in the home are Nader Fathi, Nikki Fathi, and Jessica Vargas. Mr. Fathi was the only other occupant of the home present. Additionally, 3 staff were present,. All of the adults living and working in the home had been background cleared and associated with this facility.

The Licensee maintained the capacity on the license. Under care at the time of the inspection were a total of 6 children, all preschool aged. The Licensee staff ensured that all of the children were supervised at all times.

The Licensee is utilizing the child care roster and she conducts emergency drills with children under care at least every six (6) months. The Licensee owns the facility. The on-limits areas are the building adjacent to the main home and the backyard. The home was kept clean and orderly, with heating and ventilation for safety and comfort, as well as safe toys, play equipment, and materials.

The facility had working smoke detectors, carbon monoxide detectors, and fully charged size 3A-40-BC fire extinguisher. The swimming pool had a fence that was at least five (5) feet high in compliance with Section 102417(g)(5)(A) of Title 22. The Licensee stated that there were no guns or weapons in the home. The Licensee has numerous pets.

The Licensee's files were reviewed and found to be complete. Licensee had current Mandated Reporter certification for her and her staff members, as well as current pediatric 1st Aid and CPR certificates.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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: FATHI, SETARE	FACILITY NUMBER: 434401704
	VISIT DATE: 06/29/2021

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This facility provides Individual Medical Services (IMS). LPA reviewed storage of medication, equipment, and supplies, and they were found to be handled in accordance with regulations. For IMS information, see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information was provided: US Department of Justice (USDOJ) toll-free Americans with Disabilities Act (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.

Facility Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Facility administrator was provided with CDSS Effects of Lead Exposure Informational and lead testing requirements were discussed.

No deficiency cited during today’s visit. The appeals rights and a notice of site visit were provided that is to be posted for 30 days. A copy of this report was provided and is to be kept in the facility records for a period of three years.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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