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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409008
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:56:31 PM

Document Has Been Signed on 06/12/2024 02:56 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ZANDIYEH, PEGAHFACILITY NUMBER:
073409008
ADMINISTRATOR/
DIRECTOR:		ZANDIYEH, PEGAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 981-1785
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
06/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:34 AM
MET WITH:Pegah ZandiyehTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 6/12/24 at 11:34 AM Licensing Program Analyst (LPA) Dealia Frison conducted an unannounced Annual inspection Pegah Zandiyeh Family Childcare Home. LPA met with Pegah 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 are Monday to Friday 7:00 AM to 5:00 PM. Present in the home at time of inspection were licensee, licensee's son, 2 preschool and 3 infants.

Children’s files were reviewed. The licensee has current Mandated reporter training was completed 9/22. Licensee is in compliance with required immunization's for childcare providers. Fire and disaster drills are conducted at least once every six months. A health and safety tour of inside the home was done. LPA toured the premises with licensee. There is a 3A40BC fire extinguisher, smoke alarm and carbon monoxide detector in the home.



The OFF-LIMIT areas are inaccessible to children in care by safety gates and child proof doorknobs. ON-LIMIT areas are the family room/play area, downstairs bathroom, kitchen dinning area and back yard are used as the primary areas for day-care. Medicines, cleaning products, sharp objects are stored inaccessible to children in off-limit areas. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. LPA discussed with licensee the requirements for assistant for large FCCH. LPA reminded licensee to conduct a disaster drill at least once every six months. Licensee states that there are no pets, arms and ammunition stored in the home. The fireplace is screened, and the home maintains a working telephone. 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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZANDIYEH, PEGAH
FACILITY NUMBER: 073409008
VISIT DATE: 06/12/2024
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LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ZANDIYEH, PEGAH
FACILITY NUMBER: 073409008
VISIT DATE: 06/12/2024
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Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no deficiencies cited during today’s inspection.

A notice of site visit was provided and must be posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Pegah Zandiyeh
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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