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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409681
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:34:23 AM

Document Has Been Signed on 09/26/2024 11:34 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BASHIRI TAKLIMI, S. & HASHEMI JAZZI, S.I.FACILITY NUMBER:
073409681
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Sayed Hashemi Jazzi & Shala Bashiri TaklimiTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 9/26/24 at 9:30 AM, Licensing Program Analyst (LPAs) Joe Mary Vargas and Christina Watts conducted an announced prelicensing inspection and met with the applicants Seyed Hashemi Jazzi and Shahla Bashiri Taklimi. LPA discussed the purpose of the inspection and was granted entry into the facility by the applicants. Residing in the home are only the applicants. Present during the inspection were the applicants who are both/all fingerprints were cleared. There were no children present during the inspection. The facility was toured to conduct the health and safety inspection. The facility plans to operate between the hours of 8 am - 6 pm, Sunday to Saturday. The home is a double story home with a 4 bedrooms, 3 bathrooms, living room, family room, kitchen, laundry room, garage, backyard with a covered pool and the right side backyard that is fenced which is neat and clean with heating and ventilation for safety and comfort.

ON LIMIT areas are: the living room, right side backyard which is fenced and the downstairs bathroom

OFF-LIMIT areas are: the entire 2nd floor that consist of 4 bedroom and 2 bathroom. A family room, kitchen, the left side backyard, garage, laundry room and the covered pool.

The ISOLATION AREA will be in the living room, away from other children in care.

The outdoor play area is free from defects or dangerous conditions. The family room will be used to access the on limit bathroom for child care use with the supervision of the applicant. Applicants cannot use the family room for care and supervision of children in care without inspection from licensing. There are ample age-appropriate toys that are safe, clean, and in good repair. During today's inspection, there are is a infinity pool, which is covered and made inaccessible to children. The pool cover can hold the weight of an adult. LPA did not observe any hazardous materials or toxins accessible to children. There is a fireplace in the family room that is inaccessible to prevent children's access.

LIC 809 continuation to PAGE 2 ---------------------------------------------------------------------------------------------------

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BASHIRI TAKLIMI, S. & HASHEMI JAZZI, S.I.
FACILITY NUMBER: 073409681
VISIT DATE: 09/26/2024
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The home has a fully charged 2A10BC fire extinguisher, working smoke detector, carbon monoxide detector, and fully stocked First Aid Kit. The home is equipped with a working telephone.

The applicant stated there are no firearms. There is 1 pet in the home. The applicants complies with the immunization laws pertaining to all childcare providers.

A copy of the mortgage statement was reviewed and showed control of the property. The applicants completed and received a certificate in mandated reporter training on 6/24 and 7/24. The applicant’s CPR and First Aid certificate is current and expires on the 8/25 and 2/26.

The applicants was reminded that all adults 18 and over living or working in the home, 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.

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

LPAs reviewed with the applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted, and copies were left with the applicants.

LPA's informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

LIC 809 continuation to PAGE 3 -----------------------------------------------------------------------------------------------

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: BASHIRI TAKLIMI, S. & HASHEMI JAZZI, S.I.
FACILITY NUMBER: 073409681
VISIT DATE: 09/26/2024
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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.

The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers and drop-down cribs are not allowed at the daycare facility.

The roster of the children must be properly maintained, and the fire/disaster drill every six months must be documented. The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

LPA discussed the safe sleep regulations with the applicant 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's 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.



Effective 9/26/24, the applicant is approve for the Small Family Child Care License.

The license will be issued upon final file review and manager approval.

An exit interview was conducted, and the report was reviewed with the applicants, Seyed Hashemi Jazzi and Shahla Bashiri Taklimi.

SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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