434416240-12-6-2019-07-CC-SRED-BJLR73-20191206114542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416240
Report Date: 12/06/2019
Date Signed: 12/06/2019 11:45:56 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:	SALARI, SOHEILA		FACILITY NUMBER:	434416240
ADMINISTRATOR:	SOHEILA SALARI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 791-4501
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	14	CENSUS: 0	DATE:	12/06/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Soheila Salari		TIME COMPLETED:	11:55 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) Shannel Reed met with Licensee, Soheila Salari, to conduct an announced change of location/ pre-licensing inspection to the home today. The adults that reside in the home are the Licensee, her spouse- Sayyed Massoud Eftekhar and the Licensee’s adult son- Sayyed Shahriar “Sean” Eftekhar. The Licensee and her son were present in the home today. Shahriar “Sean” help to translate information to the Licensee when needed. The Licensee states that the current hours of operation are Monday - Friday from 7:30AM to 6PM. The home has one pet (dog- Male, 11 months old) that the Licensee states is fully vaccinated. The Licensee has completed her Preventative Health and Safety Child Care Training as of 08/13/17. The Licensee’s CPR and First Aid certifications are current and expire on 12/05/21. The Licensee rents the home with her spouse and son. Proof of control of property, via the Lease Agreement was provided to LPA via email during today’s inspection. The Licensee states that she does have day-care insurance at this time. LPA informed the Licensee of the Affidavit Regarding Liability Insurance (LIC282) if at any time she no longer carried the daycare insurance. The License stated that the daycare entrance is located on the left side of the home. LPA toured the indoor and outdoor (on and off limit) areas of the home during today's inspection. LPA observed a barricaded fire place. The home does not have any stairs. Off limit areas inside the home: two bedrooms, bathroom, kitchen, living room, dining room and attached garage. Off limit areas outside the home: the right side of the home and the area outside of the designated play space, the shed and the area next to the shed. The Licensee stated that the children will be escorted and supervised at all times while outside to ensure that they do not go to the off limit areas. LPA observed a fully charged 1A10BC fire extinguisher. LPA informed that Licensee that this is not sufficient. And that a 2A10BC or larger fire extinguisher is needed. The Licensee stated that she has larger fire extinguisher at her other address, that she can move over. LPA observed and tested operational smoke and carbon monoxide detectors in the daycare rooms. *Facility Evaluation Report dated 12/06/19 to be continued on next page:*

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

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: SALARI, SOHEILA	FACILITY NUMBER: 434416240
	VISIT DATE: 12/06/2019

NARRATIVE

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Facility Evaluation Report dated 12/06/19 to be continued from previous page:
LPA observed a fenced backyard. Cleaning Products and sharps are located in the off limit kitchen. LPA reminded the Licensee that smoking, baby walkers, jumpers, and similar items are not allowed in Family Child Care Homes.

A review of records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded the 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. Currently, the Licensee her spouse, son and helper are associated to her previous address. Fingerprint Transfer forms need to be submitted to associate the individuals to this new address.

Forms of discipline used by Licensee: talking to / counseling children about the issues and/ or time out with a book. LPA discussed appropriate time out limits. The Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.
LPA reminded the Licensee that fire/disaster drills must be practiced at least once every 6 months and documented. LPA discussed the requirements of AB 633 with the Licensee and she stated that she understands the requirements. LPA also discussed "zero tolerance" related regulations with the Licensee and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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.
Facility Evaluation Report dated 12/06/19 to be continued on next page:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

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: SALARI, SOHEILA	FACILITY NUMBER: 434416240
	VISIT DATE: 12/06/2019

NARRATIVE

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Facility Evaluation Report dated 12/06/19 to be continued from previous page:
The Licensee’s immunization records and Mandated Reporter Training Certificate of completion is on file.
LPA provided Applicant with Lead Safety Information sheet and reviewed the AB2370 requirements with the Licensee.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.

A Family Child Care Home packet was reviewed and given to the Licensee.
The following Pending information was discussed: 2A10BC Fire Extinguisher or larger in the home, an accurate Facility Yard sketch noting the outside Off Limits areas, and the Transfer request forms for all adults in the home and any Assistants.

LPA conducted an exit review with the Licensee and advised her that a Large Family Child Care Home license may be granted pending the submission of the pending information and the review and approval by a Licensing Program Manager (LPM).

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

LIC809 (FAS) - (06/04)

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