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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422559
Report Date: 05/19/2023
Date Signed: 05/19/2023 03:22:05 PM

Document Has Been Signed on 05/19/2023 03:22 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHAFIEI, MEHDIFACILITY NUMBER:
013422559
ADMINISTRATOR:SHAFIEI, MEHDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 926-7745
CITY:OAKLANDSTATE: CAZIP CODE:
94618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mehdi ShafieiTIME COMPLETED:
03:30 PM
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On 5/19/2023 at 01:30 PM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required inspection at Mehdi Shafiei Family Childcare Home. LPA met with licensee and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday to Friday 08:00 AM to 06:00 PM. Present in the home at time of inspection were Licensee, licensee's wife, their adult daughter, 2 assistants and 12 preschool age children in care.

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, or transfer their existing 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.

Indoor Space: At 2:00 PM A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2 A 10 BC fire extinguisher, smoke and carbon monoxide detector in the home. The home is a two story house consisting of 3 bedrooms, 3 bathrooms, living room, family room, dining room eat-in kitchen, laundry room and garage.



The OFF-LIMIT areas are the 3 bedrooms which includes the master bedroom/bath, laundry room and garage. These areas are inaccessible to children in care by closed locked doors and visual supervision.
IN-USE The family room, living room, dining room, kitchen, bathroom behind kitchen and backyard is used as the primary areas for day-care.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SHAFIEI, MEHDI
FACILITY NUMBER: 013422559
VISIT DATE: 05/19/2023
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Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and drawers with latches. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states there are two dogs but are not present during day care hours. Licensee states there are no arms and ammunition stored in the home. The fireplace is blocked to prevent access by children in care, and the home maintains a working telephone.
Outdoor Space: AT 2:30 PM LPA toured the outdoor area (backyard) and observed it was fenced but has an open driveway. Licensee was reminded that 100% visual supervision is required when children are using outdoor area. LPA observed there are no pools, hot tubs or other bodies of water.

Children files and Facility files were reviewed. Facility contained Children's Roster, pediatric CPR and first aid expires 12/2023.

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

LPA discussed the safe sleep regulations with licensee 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 licensee 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.
No deficiencies cited today.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Mehdi Shafiei.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC809 (FAS) - (06/04)
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