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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911462
Report Date: 04/14/2022
Date Signed: 04/14/2022 09:36:37 AM


Document Has Been Signed on 04/14/2022 09:36 AM - 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, 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: 6DATE:
04/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Licensee - Dena NazarpourTIME COMPLETED:
09:50 AM
NARRATIVE
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On 04/14/2022, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced case management inspection. LPA Gavoutian was greeted by Licensee Dena Nazarpour. Present during today’s inspection were six children. Licensee had to leave the home for an appointment and LPA Gavoutian reviewed this report with Assistant Pari Aiwas. The purpose of this inspection was to verify Licensee’s adult son, Noel Nazarpour, was not living, or present, at the facility and to license a bedroom for daycare use.

Prior to exiting the vehicle, LPA Gavoutian observed a gentleman parked in front of Licensee’s home. At 8:10 a.m., LPA Gavoutian observed two children, Licensee’s minor child and Child 1, exit Licensee’s home through the garage and get into the vehicle with an adult male. Licensee later stated that the adult male, Staff 1, was transporting her minor child and Child 1 to school. Licensee stated that Staff 1 did not have fingerprint clearance and did not have a valid CPR/First Aid certificate.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, prior to initial presence in a licensed Family Child Care Home. 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.

On 04/11/2022, Licensee was provided with an Order of Exclusion informing Licensee that her son, Noel, is excluded from having contact with day care children or being physically present at any facility licensed by the Department. During today’s inspection, LPA Gavoutian was granted permission to inspect indoor/outdoor areas of the home, including bedrooms, to verify Noel was not living, or present, at the facility. LPA Gavoutian observed some of Noel’s belongings, such as clothing, shoes, and toiletries were still at the home, but Licensee stated that Noel had been staying with another relative. (Continued on LIC 809-C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: NAZARPOUR, DENA FAMILY CHILD CARE
FACILITY NUMBER: 503911462
VISIT DATE: 04/14/2022
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In addition, LPA Gavoutian provided Assistant Aiwas with form LIC 995B ‘Family Child Care Home Addendum to Notification of Parent’s Rights (Regarding Removal/Exclusion). LPA Gavoutian informed Assistant to provide LIC 995B form to parents/authorized representatives by the end of day, or by the next day child(ren) are in care. Assistant Aiwas understands parents are to sign LIC 995B acknowledging receipt of notification, stored in children’s files, and subject to review/verification by the Department during future inspections.

During today’s inspection, LPA Gavoutian inspected bedroom #1 for daycare use, per Licensee’s request. LPA Gavoutian observed an adult bed, a television stand, a television, a glass showcase, a nightstand, clothing, and shoes in the bedroom. All hazardous items were removed from the bedroom. Licensee stated the room will only be used for napping children in a play yard. Bedroom #1 has been licensed for use effective today, 04/14/2022. The areas of the home that are accessible to daycare children are the living room, dining room, kitchen, five bedrooms, two bathrooms, laundry room, and fenced backyard. Licensee understands that appropriate supervision must be provided to napping infants and the doors to the rooms where infants are napping must remain open at all times. The facility sketch, LIC 999A, was updated.

LPA Gavoutian informed facility representative Pari Aiwas that this report dated 04/14/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Gavoutian informed the facility representative to provide a copy of this licensing report dated 04/14/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the facility representative Pari Aiwas.

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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/14/2022 09:36 AM - 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: NAZARPOUR, DENA FAMILY CHILD CARE
FACILITY NUMBER: 503911462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/15/2022
Section Cited

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Criminal Record Clearance; 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. This requirement
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was not met as evidenced by:
Based on observation and interview, Staff 1 was transporting Child 1 to school and did not have a criminal record clearance. This poses an immediate risk to the health, safety, or personal rights 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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 04/14/2022 09:36 AM - 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: NAZARPOUR, DENA FAMILY CHILD CARE
FACILITY NUMBER: 503911462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2022
Section Cited

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Personnel Requirements; 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. This requirement was not met as evidenced by:
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Based on interview, Staff 1, who was transporting Child 1 to school, did not have a CPR/First Aid certificate. This poses a potential risk to the health, safety, or personal rights of children.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4