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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415190
Report Date: 06/16/2021
Date Signed: 06/16/2021 04:16:55 PM

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:BIDGOLI, LINAFACILITY NUMBER:
434415190
ADMINISTRATOR:BIDGOLI, LINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 626-8311
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: 10DATE:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lina BidgoliTIME COMPLETED:
04:30 PM
NARRATIVE
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#1 Licensing Program Analysts (LPAs), James Santos and Marilou Monico conducted an unannounced Required 1 Year Inspection visit today. LPAs met with Licensee, Lina Bidgoli and explained the purpose of the visit. Also present in the home were the licensee's 3 assistants, licensee's adult daughter and an adult visitor. There were ten (10) day care children in the home: Four (4) infants and six (6) preschool age. There are two (2) adults residing in the home: Licensee and her husband. The home has 3 bedrooms and 3 bathrooms.

LPAs toured the home inside and out with the Licensee. The home’s operating schedule is Monday through Friday from 8AM to 5:30 PM. The home has a working telephone service. The License, Notification of Parents’ Rights, Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The home was observed to be clean and organized. There were sufficient toys and play equipment for the day care children. Cleaning compounds, sharp objects, medications, and other similar items were secured. Bathroom used by children was observed to be clean and in good operating condition.

Off limit areas in the home: 2 bedrooms, 1 bathroom, living room, kitchen and garage. Off limit areas outside the home: 1 locked storage shed. There were no bodies of water observed. Per licensee, there were no weapons and poisons in the home. A fully charged 2A10BC fire extinguisher was observed in the home. LPAs observed functioning carbon monoxide and smoke detector.

LPAs obtained an updated copy of the roster of children in care. Five (5) children's files were reviewed. LPAs discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Licensee completed AB1207 Mandated Reporter Training on 4/29/2020. Licensee does not have current Pediatric CPR/1st Aid certification.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BIDGOLI, LINA
FACILITY NUMBER: 434415190
VISIT DATE: 06/16/2021
NARRATIVE
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A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions with the exception of Vannessa Duarte. Vannessa has been working in the facility since 6/1/2021 without fingerprint clearance.
LPAs 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPAs reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensees are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.

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. LPAs reviewed and provided licensee copies of the Lead Poisoning Facts Information and Safe Sleep Regulations (PIN 20-24-CCP).

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she's not planning to provide IMS at this time.

As a result of this inspection, deficiencies were cited. See LIC809D page for deficiencies.



A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BIDGOLI, LINA
FACILITY NUMBER: 434415190
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2021
Section Cited

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CRIMINAL RECORD CLEARANCE - (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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This requirement is not met as evidenced by: Vannessa Duarte started working on June 1, 2021 without fingerprint clearance associated to the facility. This poses an immediate risk to the health and safety of children in care.

Civil penalty of $500 was assessed.
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Licensee stated that Vanessa is scheduled to have her fingerprint clearance on 6/17/2021.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 3 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BIDGOLI, LINA
FACILITY NUMBER: 434415190
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2021
Section Cited

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Personnel Requirements: (c) 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.
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This requirement is not met as evidenced by: Licensee does not have current Pediatric CPR/1st Aid certification. This poses an potential risk to the health and safety of children in care.
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Type B
08/04/2021
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions: (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement is not met as evidenced by: Licensee and assistants do not have immunization against influenza, pertussis, and measles. This poses a potential risk to the health and safety of children in care.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4