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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400694
Report Date: 11/14/2024
Date Signed: 11/14/2024 03:49:46 PM

Document Has Been Signed on 11/14/2024 03:49 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SHADRAVAN FAMILY CHILD CAREFACILITY NUMBER:
198400694
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 9DATE:
11/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Licensee - Sara ShadravanTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management inspection to the above mentioned address on 11/14/24 at 1:20 PM. LPA met with licensee, Sara Shadravan, who guided LPA on a tour of the home. LPA observed 1 additional adult and 9 children present during inspection. The licensee is requesting a capacity increase to her family childcare home license. Per licensee, operation hours will be Monday to Friday, 8:00 AM to 3:00 PM. Licensee states that she will care for children 10 months to 6 years old.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home that consists of 2 bedrooms, 2 bathrooms, living room, kitchen/dining room, detached garage, front yard, and back yard. The off limit areas include 1 bedroom. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Main care area is located in the living room. LPA observed child sized table and chairs, age appropriate toys, infant changing table, and a wall mounted shelf with infant diapering supplies. A tension gate was observed in the hallway leading to the kitchen. Latch locks were observed on the cabinet beneath the kitchen sink. LPA observed knives and other pointy objects made inaccessible on top of the refrigerator. LPA observed a ceiling fan, additional age appropriate toys and napping mats in the 2nd bedroom. LPA observed the detached garage to be converted into a living space. The detached garage was observed with a stove, refrigerator, laundry appliances and a bathroom. Age appropriate toys, wooden locker for personal storage, children's reading materials, child sized table and chairs and napping equipment were observed in the detached garage. Both bathrooms were observed to be clean with an operable sink, faucet and toilet. Cleaning supplies were observed to be inaccessible on a shelf above the laundry appliances. The front yard was observed with perimeter fencing, and age appropriate outdoor play equipment. Off limit area leading to the side of the garage was observed with a gate and a latch lock. Another gate was observed leading to the back yard and entrance into the detached garage. LPA observed additional age appropriate toys, outdoor furniture and a garden.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SHADRAVAN FAMILY CHILD CARE
FACILITY NUMBER: 198400694
VISIT DATE: 11/14/2024
NARRATIVE
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Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable telephone service via a cell phone. Licensee understands that the cellphone is to remain in the home during operation hours. Both bedroom and detached garage were observed to have an air conditioning unit mounted onto the wall. LPA observed two forced air electrical heaters available in the home..The licensee was advised that any poisons must be locked, not just inaccessible. Parent board is visible in the main care area with required postings. Children will nap on cots in the main care area and the garage space designated for care. Per licensee there are no pets, there are no firearms or weapons stored in the home and there are no bodies of water. LPA did not observe any of the above items. LPA observed that the licensee has a 2A10 BC fire extinguisher in the home, with a service tag dated 08/15/24. Smoke and carbon monoxide detector were tested and are operable. The licensee states that parent will provide food for children in care, however she will offer snacks. LPA advised licensee that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.

LPA discussed the safe sleep regulations with licensee 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 also informed 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

The licensee has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Licensee has proof of required immunization records. Assistants have required training and immunization. There are first aid supplies available.

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: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SHADRAVAN FAMILY CHILD CARE
FACILITY NUMBER: 198400694
VISIT DATE: 11/14/2024
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LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov

Licensee is requesting a capacity increase to a large family child care license. Fire clearance was approved on 10/15/24. Per fire inspector, both the house and garage space have been approved for the purposes of eating, napping and activities. A large family childcare license may be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the licensee is required to comply with the terms and limitations stated on the license.

During the case management inspection, technical violations were provided on the following topics:
-Capacity; infant to licensee ratio. Overall requirements for child ratio
-Infant safe sleep
-Napping arrangements in the detached garage
LIC 9102 was provided to licensee.

A notice of site visit was given and must remain posted for 30 days

Exit interview conducted and report was reviewed with licensee, Sara Shadravan.

(page 3 of 3)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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