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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409008
Report Date: 09/13/2022
Date Signed: 09/13/2022 01:18:56 PM

Document Has Been Signed on 09/13/2022 01:18 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:ZANDIYEH, PEGAHFACILITY NUMBER:
073409008
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Pegah ZandiyehTIME COMPLETED:
01:30 PM
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On 9/13/2022, Licensing Program Analysts (LPAs), Melissa Domantay and Melissa Guirit conducted an in-person case management/increase in capacity inspection. Present during today's inspection were the licensee, 2 infants, 1 preschool aged child, and fingerprint cleared son. The on limit areas of home was toured to conduct a health and safety inspection with the licensee. Hours of operation for day care are Monday through Friday 7:00am to 5:00pm.

Facility is pending fire clearance for an increase of capacity for a large family day care home.

The home is a 2 story house which is neat and clean with heating and ventilation for the safety and comfort of the children. The day care is located on the bottom level of the home. The primary space used for the daycare is the family room area, kitchen and backyard. There is one (1) restroom available to children. Off limit areas are made inaccessible by use of gates, closed and/or locked doors and visual supervision. There are age appropriate toys in the home. The isolation are will be in the living room on the couch. Outdoor back yard has sufficient amount of shade, fully fenced, and no bodies of water on the property. Home has heat and air. Wall heater is in a secured closet. There is a garage, which is locked. Overall, the home appears clean and safe. Per licensee, there are no firearms in the home. LPAs did not observe any hazardous materials or toxins accessible to children during today's inspection.

The home has a fully charged 3A40BC fire extinguisher, working combo smoke detector and carbon monoxide detector, first aid supplies and working telephone.

See 809-C for continuance.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2022
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: ZANDIYEH, PEGAH
FACILITY NUMBER: 073409008
VISIT DATE: 09/13/2022
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The Licensee's CPR and First Aid certificate is current and expires 02/2024.

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.

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 observed at this visit. This family day care home is pending to become a large family childcare home awaiting fire clearance.


A copy of this report and a copy of "A Child Care Provider's Guide to Safe Sleep" was provided during the visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Pegah Zandiyeh.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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