434416213-9-25-2019-07-CC-TDON-BGCNCZ-20190925102134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416213
Report Date: 09/25/2019
Date Signed: 09/25/2019 10:21:57 AM

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:	NIKFARJAM, MOJGAN		FACILITY NUMBER:	434416213
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	09/25/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Mojgan Nikfarjam		TIME COMPLETED:	10:30 AM

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) Tuoc Doan conducted an announced, Prelicensing inspection of the home today. LPA met with the Applicant Mojgan Nikfarjam and Applicant's Daughter Newsha Nikfarjam. Applicant is applying for a license to operate a Small Family Child Care Home with a maximum capacity of 8 at the address listed above. Days and hours of operation will be Monday through Sunday: 08:00 AM to 05:30 PM; and 06:30 PM to 07:00 AM A copy of the lease agreement is on file. LPA inspected the indoor and outdoor areas of the home. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. Areas inside the home that are off limit to children are: the Master Bedroom and Bath, the Bedroom across from the Master Bedroom, and the Garage. LPA observed child safety gate installed in the middle of the hallway to prevent children from accessing the door of the Master Bedroom and the bedroom across from it. The home was furnished with children's toys, and furniture and equipment, such as tables, chairs, cots, etc. The backyard is enclosed by fencing and is used for outdoor activities. Outdoor play equipment was observed and were in good condition. There were no bodies of water observed. Applicant stated that there are no weapons such as firearms in the home. LPA observed a fully charged 2A:10BC fire extinguisher. LPA reminded Applicant that the fire extinguisher needs to be serviced every year. Smoke and Carbon Monoxide detectors were tested and proved to be functioning. Applicant understands that fire/disaster drills need to be practiced at least once every six months. Cleaning products, medications, sharp objects and other items that may pose as a danger to children in care were stored inaccessible to children. LPAs informed Applicant that poisons need to be locked up. Smoking and baby walkers are not to be used for day care children. Applicant has current certification for Pediatric CPR and First Aid that expires on 07/13/2021, and she had completed Preventive Health and Safety training. Applicant's AB1207 Mandated Reporter Training Certification expires on 01/26/2021. Applicant has record of her immunization against Measles and Pertussis.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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: NIKFARJAM, MOJGAN	FACILITY NUMBER: 434416213
	VISIT DATE: 09/25/2019

NARRATIVE

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Adults over the age of 18 and reside in the home are Applicant, and Applicant's Spouse and two Adult Daughters. They have Clearances for Criminal Background and Child Abuse Index Checks and Tuberculosis.
LPAs reminded Applicant 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.

Applicant will use talking and redirection as forms of discipline. Applicant understands that children's personal rights should not be violated; including no corporal punishment. LPAs discussed with Applicant methods of isolating sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, healthy beverage law, and requirements for Assistant Providers. Applicant understands that she has to be present during 80% of day care operating hours. LPAs informed Applicant that if she decides not to carry liability insurance for her day care operation, she will need to maintain a file of affidavit signed by the parents regarding her liability insurance.

LPAs reviewed with Applicant the violations that would result in an immediate assessment of civil penalty in the amount of $500. Applicant is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, 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 provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe Sleep information was also reviewed and provided to Applicant.

Exit interview was conducted, where this report was reviewed with Applicant Mojgan Nikfarjam and Applicant's Daughter Newsha Nikfarjam. Based on today's inspection, LPAs determined that the home is in compliance with applicable Health & Safety Codes and Title 22 Regulations.

Therefore, Applicant was informed that Applicant's file will be submitted to Licensing Management for final review. Once final review is completed, Applicant will be issued a license to operate a Small Family Child Care Home at this address.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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