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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414254
Report Date: 11/15/2019
Date Signed: 11/15/2019 11:58:00 AM

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SABAHI, SEYEDFACILITY NUMBER:
434414254
ADMINISTRATOR:SABAHI, SEYEDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4086493028
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:14CENSUS: 2DATE:
11/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Sabahi SeyedTIME COMPLETED:
12:10 PM
NARRATIVE
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On November 15, 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of the family day care home. LPA met with Licensee, Seyed Sabahi and explained the purpose of today's inspection. Upon LPA’s arrival Licensee was present with two 2 children in care.

Days and hours of operation are Monday through Friday from 07:00 AM – 6:00 PM. Licensee understands the capacity options and understands that the maximum capacity for a large family child care home is 14 children. Licensee stated that he understands that when there is only one care provider present, the home must comply with the capacity of a Small Family Child Care Home License, which has a maximum capacity of eight.

Licensee resides in the home with mother (Khadijeh Khanom Saeedi) They have Clearance for Criminal Background and Child Abuse Index Background Checks.
A review of staff records on 011/13/2019 show that individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, 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.

Licensee has records showing proof of immunity against Measles and Pertussis. Licensee's AB1207 Mandated Reporter Training Certificate expires on 09/19/2020.


A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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: SABAHI, SEYED
FACILITY NUMBER: 434414254
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2019
Section Cited

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PERSONNEL REQUIREMENTS. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
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Per LPA's review of Certifications, Licensee CPR/First Aid training from "PediaticPlus has expiered (06/3/19) . This poses a potential risk to the health and safety of children in car
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Completion of the Training shall be no later than 15 Calendar days from today, 11/15/19. A copy of the current and approved Pediatric CPR/First Aid Certification will be sent to Licensing Office to show proof of correction.

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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: SABAHI, SEYED
FACILITY NUMBER: 434414254
VISIT DATE: 11/15/2019
NARRATIVE
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LPA reviewed the roster of children in care and a copy was obtained. LPA reviewed the children's files. Records reviewed include Parents' Rights, immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. The form LIC 282 "Affidavit Regarding Liability Insurance" were kept in the children's file.
LPA inspected the indoor and outdoor areas of the home. The second floor is off limits a gate at base of staircase was observed, garage off limits. Smoke and Carbon monoxide detectors were tested and proved to be functioning. Fire and disaster drills were last conducted and recorded on 09/12/2019. LPA observed a fully charged fire extinguisher. The fireplace is screened. Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. Licensee states that there are no weapons in the home A fully fenced backyard was observed with appropriate play equipment. There were no bodies of water observed.

Licensee stated he does transport children. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

Licensee states that currently he is not providing Incidental Medical Services. 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.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.
Safe sleep information was reviewed with Licensee.
LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Regulatory violation were observed during the inspection visit. Therefore, citation was issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licensee. A copy of this report was given to Licensee.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC809 (FAS) - (06/04)
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