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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415755
Report Date: 04/29/2022
Date Signed: 04/29/2022 02:13:31 PM


Document Has Been Signed on 04/29/2022 02:13 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:MIMIZ DAYCARE CENTERFACILITY NUMBER:
434415755
ADMINISTRATOR:MARYAM YOOSEFIFACILITY TYPE:
830
ADDRESS:3225 S. WINCHESTER BOULEVARDTELEPHONE:
(408) 482-6776
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:24CENSUS: 12DATE:
04/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Mahmood GhasemianTIME COMPLETED:
02:27 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection visit today. LPA met with Director, Mahmood Ghasemian and discussed the purpose of the visit.

LPA toured the center with the Director. LPA observed the required documents which includes the Facility License, Emergency Disaster Plan, Earthquake Preparedness Checklist, Parents' Rights Poster, Personal Rights, Child Car Seat Law, Food Menu, and Daily Activity Schedule are posted prominently on the walls. The Center's operation days and times are Monday through Friday from 8:00AM to 5:30PM.

The infant program uses 4 rooms including the crib room. The infant rooms have trash cans and solid waste containers with tight fitting lids for disposals. There are three (3) sinks available for the infant children. Fire extinguishers and smoke/carbon monoxide detectors were observed in each rooms. LPA observed refrigerator and bottle warmers in the infant room. Highchairs and cribs were observed to be in good condition. Rooms are furnished with age appropriate toys.

LPA observed appropriate changing tables that have raised sides (3 inches in height) and are within an arm's reach of a sink in each room. There is a separate sleeping area in the crib room. Infants that don't require cribs nap on cots. Director stated that parents provide baby food and formulas and diapers. Children's formulas are properly stored and placed in refrigerator if needed. The center provides meals to children 1 year or older.

The kitchen and food preparation area is functional and has running water, sink, refrigerator and storage space for food. Disinfectants, cleaning solutions and other chemical items and sharp objects are stored and inaccessible to children. Staff have separate lounge room and bathroom. Director stated they do not have poisons, weapons and ammunition on the premises

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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
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: MIMIZ DAYCARE CENTER
FACILITY NUMBER: 434415755
VISIT DATE: 04/29/2022
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 04/29/2022

LPA observed that the infant playground areas is surrounded by appropriate fencing and is separate from the preschool playground areas. The playground equipment is age appropriate. There are climbing structures in the infant playground and artificial grass with rubber padding is used as resilient materials. Shade is provided by trees, canopies, and covered patio areas. There are adequate equipment, supplies, and toys for children outdoors. There are no bodies of water or any hazards observed.

LPA reviewed children's files. Children's records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Immunization Record and Infant Needs and Services Plan.

LPA reviewed staff files. Staff records reviewed include Criminal Record Clearance, Statement Acknowledging Requirement to report Child Abuse, Immunization Record, CPR/First Aid, Mandated Reported Training, Qualifications and Education. Per review of record, the center conducts emergency disaster drills at least twice a year.

Per Director, they do not provide transportation to children and also do not provide incident medical services. Director understands that walkers and items of similar nature are not permitted.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director 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 Director 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.

LPA advised Director to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.



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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
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: MIMIZ DAYCARE CENTER
FACILITY NUMBER: 434415755
VISIT DATE: 04/29/2022
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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 04/29/2022)


As a result of this inspection, a deficiency has been cited. See LIC809D for deficiency. Appeal rights were reviewed and provided.

Exit interview conducted and report was reviewed with the Director. LPA advised Director 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

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 04/29/2022 02:13 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: MIMIZ DAYCARE CENTER
FACILITY NUMBER: 434415755

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
(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.
Deficient Practice Statement
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This requirement is not met as evidenced by:

Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Six (6) staff records reviewed showed their Mandated Reporter Training certifications have expired.
POC Due Date: 05/27/2022
Plan of Correction
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Director 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 5/27/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4