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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400594
Report Date: 08/25/2023
Date Signed: 08/25/2023 04:00:00 PM

Document Has Been Signed on 08/25/2023 04:00 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, 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: 4DATE:
08/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Cynthia EmamiTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 Year inspection. LPA met with Licensee Cynthia Emami who guided LPA on a tour of the facility. Upon arrival LPA observed the Licensee caring for four (4) preschool children. There are seven children enrolled attending the facility at different times. All residents associated with the facility were noted.

At approximately 1:30pm all areas identified on the facility sketch were inspected. This is a single one story home comprised of three (3) bedrooms, one bathroom, dining area, living room, kitchen, backyard, side space and attached garage. The Licensee uses the living room, a large converted bedroom (main daycare area), dining area, one bathroom, one bedroom and the back yard for care. The areas off limits to children are: one bedroom, part of the backyard and the garage. LPA informed Licensee to contact the department if she wants to use other areas of the home and always ensure hazards are inaccessible.

All areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. Between 1:30pm and 2:00pm LPA observed age appropriate toys and equipment inside the home and in the backyard. LPA advised Licensee to ensure careful supervision when children play in areas that provide cover like backyard areas. The backyard is surrounded by fencing approximately 5 feet high. There is a working phone maintained in the home. There are no pets in the home. LPA advised Licensee to provide extra care and supervision if she decides to have pets as they can be unpredictable. LPA observed detergents, cleaning compounds, medications, and other items which can pose a danger to children to be inaccessible (in areas or out of children's reach). LPA informed Licensee that poisons must be locked with a key or combination lock.

LPA discussed regulations regarding firearms. Per Licensee there are no bodies of water and LPA did not observe any on the premises. The License, Parents Rights Poster, and Earthquake Preparedness was posted. The children's roster and Disaster drill is current (last date of drill July 18, 2023. Continued:
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: EMAMI FAMILY CHILD CARE
FACILITY NUMBER: 198400594
VISIT DATE: 08/25/2023
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LPA observed the Licensee has the required current Mandated Reporter training expiring in June 1, 2024. LPA observed that the Licensee has documentation indicating immunization regarding measles, pertussis and tuberculosis on file.

LPA reviewed six children's files to be in compliance. The files included the following documentation: LIC 282 Affidavit for Liability insurance, Immunization Records, LIC 700 Identification and Emergency, LIC 627 Consent for Emergency Treatment, LIC 995A Notice of Parents Rights, LIC 9150 Additional Children in Care. LPA also observed a Safe Sleep log for napping children under two (2). There are no children under one.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, or any other item that falls into that category are not permitted in the facility. The Department does not recommend. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. Licensee's CPR expires March 2025.

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
LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA explained form is available on CCLD website. The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee of PIN 20-24-CCP.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: EMAMI FAMILY CHILD CARE
FACILITY NUMBER: 198400594
VISIT DATE: 08/25/2023
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LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA advised Assistant Director that all adults 18 years of age and older providing Care & Supervision and having a continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. If away from the facility, staff must be with children at all times (especially when outdoors).

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/tion-process.

LPA advised licensee regarding Safe Sleep PIN 20-24-CCP also discussed ratio and capacity. There were no Title 22 deficiencies cited at this time.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Cynthia Emami.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
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