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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423671
Report Date: 03/03/2023
Date Signed: 03/03/2023 11:01:03 AM

Document Has Been Signed on 03/03/2023 11:01 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHARIFI, SHADIFACILITY NUMBER:
013423671
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:18 AM
MET WITH:Shadi SharifiTIME COMPLETED:
11:14 AM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 8:18 a.m. The licensee was present with her own infant child. Phone number and e-mail address are current. Hours: 8:30 a.m. - 4:30 p.m.
At 8:30 a.m., the following was observed: the day care area of the home was inspected. Areas licensed for child care: downstairs large room, bathroom, kitchenette, and sleep room. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision.
The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use.
Facility has functioning cell phone, carbon monoxide detector, smoke detector, and fire extinguisher (3A:40:BC). Stairs inside the home are blocked with a closed door. Licensee stated there were no firearms or bodies of water on the premises. There was previously a fireplace, but it has been closed off. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Back yard area is securely fenced. Licensee has a child-sized kitchen, pull toys, a slide, riding toys, and other outdoor toys for child play. Licensee currently has 1 infant in care over 12 months of age, in which a sleeping plan is not required. Licensee has been logging safe sleep information. LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources/safe-sleep as an additional resource. Safe Sleep Handouts were also given to the licensee. 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.
Documentation has been maintained for each 15 minute check. Licensee states infants have been supervised while sleeping, and is aware of the signs to be aware of: labored breathing, skin color, increase in body temperature and restlessness. Licensee states that infants sleep on their backs. (continued)
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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: SHARIFI, SHADI
FACILITY NUMBER: 013423671
VISIT DATE: 03/03/2023
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Licensee can visually observe when a child wakes up. Older children sleep on cots. Sheets are replaced when soiled or wet, and individual bedding is only used by one child only. Bedding is washed weekly.
LPA reviewed personnel, facility, and children's records at 9:26 a.m. Licensees' CPR/First Aid expires 5/15/23. Licensee's Mandated Reporter Training expires 10/08/23. Last disaster drill completed on 1/12/23. Facility roster was current. Required postings are visible for public review. Children's files are complete.
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 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; children are not to be left in parked vehicles; car seats and high chairs; Unusual Incident Reporting; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; ill children in home, and the Guardian background check process.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Important E-mail Addresses:
Community Care Licensing :www.ccld.ca.gov.
Mandated Reporter Training:www.mandatedreporterca.com - Child Care Provider
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/ cdss-programs/community-care-licensing/caregiver-background-check/guardian

NO DEFICIENCIES CITED.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Shadi Sharifi.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
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