073409455-9-27-2023-02-CC-MMAR-CW3NLM-20230927103345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409455
Report Date: 09/27/2023
Date Signed: 09/27/2023 10:34:21 AM

Document Has Been Signed on 09/27/2023 10:34 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:	LOTFY REZVANI, MANA		FACILITY NUMBER:	073409455
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	09/27/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mana Lotfy Rezvani		TIME COMPLETED:	11:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 9/27/23 Licensing Program Analyst (LPA) Monica Mathur conducted an announced CHANGE OF LOCATION Pre-licensing Inspection at Mana Lotfy Rezvani's home and met with Applicant, Mana who has applied for a Small Family Child Care Home with a capacity of eight (8). Days and hours of operation will be Monday – Friday from 7:00 am - 5:00 pm. Applicant and her spouse live in the home, have Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Present during today's inspection were Mana and her spouse. Applicant has 8-hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8-hour Pediatric CPR & First Aid (expires 12/2024), documentation for Measles, Pertussis, Influenza opt out statement for the current flu season. Home is two story. LEVEL 1: On-Limits - Bedrooms 1, 2, Family room, Dining room, Kitchen, Living room, Bathroom. Off-Limits: attached Garage LEVEL 2: Entirely Off-Limits - 3 Bedrooms, 1 Bathroom Isolation Area: Bedroom near front entrance Indoor space of the home is sanitary and orderly, with heating and ventilation for safety and comfort. Stairs to Second Level are barricaded. Fireplace is located in the Living Room and is screened/barricaded. LPA observed fully charged fire extinguisher, working smoke, carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets. LPA reminded that smoking, baby walkers, bouncers, johnny jumpers, saucer chairs and similar items are not allowed in family childcare homes. OUTDOOR On-Limits: Main Backyard Off-Limits: Left Side yard (inaccessible by a latched gate) The yard has fences on all sides. No bodies of water were observed.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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: LOTFY REZVANI, MANA	FACILITY NUMBER: 073409455
	VISIT DATE: 09/27/2023

NARRATIVE

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Applicant provided proof of control of property. LPA discussed and reminded Applicant day care needs to be operated within the limitations and capacity of a Small Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours. Applicant was reminded that they must notify CCLD before an off-limit area is to be added to day care use and when there are structural changes/construction activity planned at the home.

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) or (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 Applicant, 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. LPA also informed applicant 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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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: LOTFY REZVANI, MANA	FACILITY NUMBER: 073409455
	VISIT DATE: 09/27/2023

NARRATIVE

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On 9/8/23 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Website links for provider resources:
Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
Guardian Background Check: www.guardian.dss.ca.gov

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.

Applicant, Mana was informed of the MyChildCarePlan.org site, 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.

The family home is recommended for Small Family Childcare Home license effective 9/27/23. Exit interview conducted and report was reviewed with the Applicant, Mana Lotfy Rezvani.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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