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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419815
Report Date: 11/09/2022
Date Signed: 11/09/2022 12:09:07 PM


Document Has Been Signed on 11/09/2022 12:09 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:SANDRES FAMILY CHILD CAREFACILITY NUMBER:
197419815
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
11/09/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Siria Sandres, LicenseeTIME COMPLETED:
12:15 PM
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On 11/09/2022 Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced inspection to insure that the licensee is in compliance with Title 22 Code of Regulation per the Decision and Order (CDSS No. 7821350001) in the matter of HUMAN SEYEDI ((Human Seyedi aka Hooman Seyedi aka Homan Reza Seyed) spouse of licensee, that went into effect on November 03, 2022. Upon arrival LPA met with licensee, Siria Sandres. There were 2 children (1 infant) observed in care. Licensee’s operating hours are Monday-Friday, 6:00am to 6:00pm. Licensee provided a tour of the facility to LPA. LPA observed a two bedroom home, one bathroom, living room, dining room (Main Child Care Room) and kitchen. Licensee stated only herself and one son live at the facility.

LPA discussed the reason for the inspection, which is due to the Decision and Order which was put into place on November 03, 2022 by the Department. Licensee states she received a copy of the Decision and Order regarding HUMAN SEYEDI (Human Seyedi aka Hooman Seyedi aka Homan Reza Seyed) Licensee states she understands that the request for a criminal record exemption was denied and HUMAN SEYEDI ( (Human Seyedi aka Hooman Seyedi aka Homan Reza Seyed) is prohibited from employment in, presence in, and contact with clients of any facility licensed by the Department. LPA did not observe HUMAN SEYEDI in the home on this date.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SANDRES FAMILY CHILD CARE
FACILITY NUMBER: 197419815
VISIT DATE: 11/09/2022
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Licensee also stated during inspection that she has hired Legal Representation, and as of October 26, 2022 a judgement was filed for dissolution of marriage to Hooman Seyedi. LPA obtained copies of dissolution documents and facility roster during inspection.

During inspection LPA provided and discussed with licensee updated documents to be posted in a publicly accessible area at facility. LPA discussed and provided the safe sleep for baby pamphlet and booklet during inspection. LPA requested licensee to test the Carbon and Monoxide and Smoke detector during inspection, both seem to be working in operable condition.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.



Exit interview was conducted with licensee, copy of report was given. Appeal Rights were issued and discussed.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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