198400594-9-28-2023-54-CC-WBIS-CW4QPW-20230928122126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400594
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:21:47 PM

Document Has Been Signed on 09/28/2023 12:21 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 CARE		FACILITY NUMBER:	198400594
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	09/28/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Cynthia Emami		TIME COMPLETED:	12:33 PM

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	Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management inspection for the purpose of a inspecting the facility due to the Licensee's request to increase capacity (from a small childcare 6 to 8 to a Large 12 to 14). Upon arrival, LPA met with Licensee Cynthia Emami who guided the analyst on a tour of the facility. Per applicant, hours of operation will be Monday through Friday 7:00AM to 6:00PM and the facility will provide care for children 0-12 years of age. LPA observed the Licensee caring for five children (three preschool and two infants which is in capacity and ratio compliance). Individuals residing in the home were noted. Between 09:55am and 10:20am 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, kitchen, two bedrooms and the back yard for care. The areas off limits to children are: an inaccessible space in the backyard and the garage. All areas accessible to children were inspected to ensure they are clean and orderly with ventilation and heating for the safety of the children. Between 10:00am and 10:30am 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 in the backyard (such as play houses and small bush areas). The backyard is surrounded by fencing approximately 5 feet high. There is a working phone maintained in the home and no pets. 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 inaccessible 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 in visible areas. The children's roster and Disaster drill is current (last date of drill July 18, 2023).

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: 09/28/2023

NARRATIVE

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The following was discussed with the applicant: Individuals who are 18 years of age or older living in the home or in the presence of children must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.
Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
Fire and safety drills must be performed every six months and documented for review by the Department.
Smoking is prohibited in a family child care home.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, (We do not recommend trampolines) or any other item that falls into that category are not permitted in the facility. Smoking on the premises is prohibited.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children, adults and review documentation.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
Liability Insurance was discussed. LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: 09/28/2023

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H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunization.

· Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

LPA advised the applicant to sleep infants where they can be directly supervised at all times and advise to conduct periodic checks according to PIN 20-24-CCP if infants sleep in a separate room. The Licensee states she will sleep infants in a separate room and conduct periodic checks according to PIN 19-02-CCP Safe Sleep Awareness Campaign which has links to information on Safe Sleep and SIDS. LPA reiterated to implement Sleep Sleep logs for children under two (2) and LIC 9227 forms for children under one (1).

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 applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:

Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224 if applicable).

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: 09/28/2023

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FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149 if applicable), Property Owner/Landlord Notification Form (LIC 9149).

INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME – You are required by Law to post the following:
Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

Note: LPA also informed Licensee that children must not sleep in swings and must be transported to a crib or pack and play type sleeping equipment immediately before a child falls asleep.

Based on today's facility inspection and the approved September 21, 2023 Fire Clearance, the Licensee will be granted a Large Family Childcare license for a capacity of 12-14 children. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license (which includes ratio and capacity).

Exit interview was conducted with Licensee Cynthia Emami. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC809 (FAS) - (06/04)

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