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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911462
Report Date: 03/25/2021
Date Signed: 03/25/2021 03:17:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:NAZARPOUR, DENA FAMILY CHILD CAREFACILITY NUMBER:
503911462
ADMINISTRATOR:NAZARPOUR, DENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 202-6480
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:14CENSUS: 0DATE:
03/25/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dena NazarpourTIME COMPLETED:
03:30 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On March 25, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Dena Nazarpour for a pre-licensing/change of location inspection. Applicant, her husband, her adult son and one minor child reside in the home. Verified Applicant’s CPR and First Aid was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on September 26, 2022. Applicant's Assistant, Viealet Nazarpour completed the training through American Heart Association and expires on January 31, 2023. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on March 22, 2021.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on March 22, 2021. Fire alarm is located in the home’s hallway on the right hand side wall.
  • This is a single story, five bedrooms and three and a half bathrooms home and children will have access to the living room, dining room, kitchen, bedroom #1 (master/day care room), bedroom #2 (day care room), bedroom #3 (day care room), bathroom #1 and bathroom #2. Off-limits rooms are made inaccessible by then use of plastic doorknob covers and doorknob locks.
  • There is a fireplace in the living that applicant states it will not be used during day-care hours.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
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 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: NAZARPOUR, DENA FAMILY CHILD CARE
FACILITY NUMBER: 503911462
VISIT DATE: 03/25/2021
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  • Applicant completed the Mandated Reporter Training on January 27, 2020. Applicant’s Assistant completed the training on March 8, 2021.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 5:30 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register



Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.
  • Applicant will make the master bathroom inaccessible to the day care children. LPA observed items that can be a potential danger to the day care children.


Pending verification of correction of the above item and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: NAZARPOUR, DENA FAMILY CHILD CARE
FACILITY NUMBER: 503911462
VISIT DATE: 03/25/2021
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  • LPA observed children size furniture, safe toys and books in bedroom #2 and bedroom #3. Children will nap in bedroom #1, bedroom #2 and bedroom #3. Applicant understands she is to supervise children at all times.
  • Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Preventative Health and Safety class was completed on September 24, 2016.
  • Knives are stored inside the kitchen pantry on a top shelf. Medication are stored inside a top kitchen cabinet that is located above the microwave. Cleaning compounds are stored in the laundry room inside a top cabinet that is made inaccessible by the use of a child proof safety latch.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There are no bodies of water in the home or premises.
  • There is a small dog that is kept indoors and will be accessible to the day care children. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Firearms are stored in accordance with Title 22 Regulations and ammunition is stored separate in accordance with Title 22 Regulations.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
  • Fenced backyard has a cemented and artificial sodded area for the day care children.
  • SB 792 immunizations verified and on file.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
LIC809 (FAS) - (06/04)
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