434411132-4-22-2022-07-CC-JGSS-CDQUV8-20220422155442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411132
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:55:09 PM

Document Has Been Signed on 04/22/2022 03:55 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GHOLALMI, FARIDEH & RASTBAF, FARIBA		FACILITY NUMBER:	434411132
ADMINISTRATOR:	FARIDEH& FARIBA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 978-1135
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY:	14	CENSUS: 5	DATE:	04/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Farideh Gholami		TIME COMPLETED:	04:15 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), James Santos conducted an unannounced Required 1 Year Inspection visit today. LPA met with Licensee, Farideh Gholalmi and explained the purpose of the visit. Co-licensee, Fariba Rastbaf was not present during today's visit. Present also in the home during today's inspection were 5 children: 2 infants and 3 preschoolers. The hours of operation of the day-care home is 7:30AM to 5:00PM, Monday through Friday. LPA toured the home inside and out with the Licensee. Off limit areas in the home are: living room, kitchen, staff bathroom. There is a fireplace in the home which is barricaded. Cleaning supplies and other hazardous items are stored and inaccessible to children. LPA observed that there is sufficient amount of toys for children. Bathroom for children was observed to be clean and sanitary. LPA observed a fully charged fire extinguisher, smoke and carbon monoxide detector. Licensee stated that there are no weapons or firearms stored in the premise. Outside play area was observed to be free of hazards. There are no bodies of water observed. Licensee does not currently transport children, but understands that children cannot be left alone and unattended in parked vehicles. Licensee stated that they currently do not have any children in care who requires Incidental Medical Services. Licensee and her Co-licensee's (Fariba Tastbaf) records were reviewed. Both Licensees Mandated Reporter Training certifications have expired in January 2022. The five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to Consent for Medical Treatment and parent's rights.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GHOLALMI, FARIDEH & RASTBAF, FARIBA	FACILITY NUMBER: 434411132
	VISIT DATE: 04/22/2022

NARRATIVE

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LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA discussed with Licensee the Infant Safe Sleep information.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

LPA conducted an exit interview with Licensee upon conclusion of today's inspection and advised them of the required "mandated reporter" training for Assembly Bill, AB 1207 requirement for Child Care Providers that all staff must complete and renew every two (2) years. The website for the online training is: http://www.mandatedreporterca.com

As a result of this inspection, a deficiency has been cited. Appeal rights were reviewed and provided.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/22/2022 03:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GHOLALMI, FARIDEH & RASTBAF, FARIBA	FACILITY NUMBER: 434411132
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, staff/care providers did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Both Licensee and Co-licensee's Mandated Reporter Training certifications have expired in January 2022.
	POC Due Date: 05/23/2022
	Plan of Correction
1 2 3 4	Licensee stated they will complete the mandated reporter training for AB 1207 and submit proof of completion of training to CCL by POC due date of 5/23/2022

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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