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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400594
Report Date: 07/21/2022
Date Signed: 07/21/2022 11:30:53 AM

Document Has Been Signed on 07/21/2022 11:30 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:EMAMI FAMILY CHILD CAREFACILITY NUMBER:
198400594
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/21/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Cynthia EmamiTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Warren Birks conducted a pre-licensing inspection. LPA Birks met with Applicant Cynthia Emami who guided analyst on a tour of facility. The applicant is requesting a Small Family Child Care license (with a capacity up to 6 to 8 children). Per applicant, the hours of operation will be Monday to Friday, 7:00AM to 6:00PM. Applicant states that she will care for children 0 months to 12 years old. An entrance Checklist was provided to the applicant during inspection. Individuals residing in the home were discussed and noted.

At 9:00am all areas identified on the facility sketch were inspected, including off limit areas. This is a single one story home comprised of three (3) bedrooms, one bathrooms, dining area, living room, kitchen, backyard, side yard and attached garage.



Areas used by children include: Large Bedroom addition/daycare room, Living room, kitchen, one bedroom, bathroom, and backyard.
Areas off limits include: one bedrooms, garage, a small gated portion east-side of backyard

Per applicant, the children will use the restroom located in the hallway and off limit rooms will be made inaccessible by door knob covers. LPA inspected all areas used by children for safety, comfort, cleanliness, telephone service, ventilation and heating. The applicant was advised that any poisons must be locked with a key or combination lock. Applicant will keep poisons in areas that are inaccessible to children. Note: LPA observed the play area has a Dutch door (half door) that can close and lock for separation and still maintain supervision. There are age appropriate toys, play equipment and books available for children.

The applicant understands that licensing staff may have access to off-limit areas during inspection visits if necessary. Per applicant, there are no firearms, weapons or bodies of water on the premises and none were observed. The applicant has no pets and LPA did not observe any during the visit.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: EMAMI FAMILY CHILD CARE
FACILITY NUMBER: 198400594
VISIT DATE: 07/21/2022
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The valve on the 2A10BC fire extinguisher indicates fully charged, and is due for service or replacement by 05/22/23. LPA advised that a receipt or service tag be attached for annual proof of purchase or service. LPA observe and tested a smoke and carbon monoxide detector (hallway and daycare room) that were operable.

The applicant states that they will provide food for children in care. Some parents may provide food as well. LPA informed applicant to ensure that food brought from home is labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition & Lead Training and Pediatric First Aid and CPR which expires 03/2023. There are first aid supplies available.

Applicant states that they will care for infants. LPA advised the applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. The applicant states the following supervision plan for infants: Applicant states that infants will sleep in a separate room and will provide supervision sometimes directly and document 15 minute checks. LPA provided applicant a PIN 20-24-CCP and reviewed an LIC 9227 Safe Sleep form. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage:

https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, 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.



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: http://www.ada.gov/childqanda.htm

LPA discussed with 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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: EMAMI FAMILY CHILD CARE
FACILITY NUMBER: 198400594
VISIT DATE: 07/21/2022
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LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care
Licensing website at: www.ccld.ca.gov.

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, 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.

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.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. Applicant was reminded of all the terms and conditions noted on the LIC 279 – Application of a Family Child Care Home that applicant signed and agreed to.



Based on documentation and inspection, the applicant will be approved for a Small Family Child Care License. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Exit interview was conducted with Applicant Cynthia Emami. This report along with a copy of the appeal rights was provided.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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