214005033-1-29-2025-05-CC-JNAS-DDE38U-20250129170207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005033
Report Date: 01/29/2025
Date Signed: 01/29/2025 05:02:47 PM

Document Has Been Signed on 01/29/2025 05:02 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	NOJABAEI, SOROOR		FACILITY NUMBER:	214005033
ADMINISTRATOR/ DIRECTOR:	NOJABAEI, SOROOR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 785-2878
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	01/29/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Soroor Nojabaei		TIME VISIT/ INSPECTION COMPLETED:	05:15 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	On January 29, 2025, at approximately 2:00PM, Licensing Program Analysts (LPAs) Naves and Tse conducted an unannounced annual inspection and met with Licensee Soroor Nojabaei. LPAs explained the purpose of the inspection and was granted access to the property by the Licensee. A helper is present today. Four children are present today (two infants and two preschoolers). The Licensee is in compliance with licensing capacity and ratio requirements today. All adults who live or work in the house have a criminal background clearance. The physical plant has not changed, and the off-limits and childcare areas are the same. The Licensee owns the home. Daycare areas: Entire Downstairs area (Yard Area, Nap room #1, Playroom, and Bathroom #3) Off-limit areas: Entire Upstairs Area (Deck Area, Living room, Kitchen, Bathrooms 1 & 2, Bedroom #1, Bedroom #2, Bedroom #3 and Bedroom #4). All restricted daycare areas have been appropriately blocked off from the children. Licensee has liability insurance. According to the Licensee, when a child displays indications of illness, the Licensee will separate and have the child wait in the nap room while contacting the parent to pick them up. The days and hours of operation are Monday through Friday, 8:00 am to 4:30 pm. LPAs inspected the facility for health and safety concerns. The childcare environment has age-appropriate activities, books, and play materials. LPAs observed a broken fence leading to upper garden area and advised Licensee to remove it. Licensee immediately removed it. LPAs observed a wooden platform with uncovered corners in the Yard Area. LPAs advised could be a tripping hazard and Licensee stated she understood. LPAs observed the shower in Bathroom #3 had toys stacked inside and the door was unsecured. LPAs advised that toys should not be stored in the shower but if they are, the shower door should be secured. Continued on page 2 >>>>

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOJABAEI, SOROOR	FACILITY NUMBER: 214005033
	VISIT DATE: 01/29/2025

NARRATIVE

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The home has proper heating, lighting, and ventilation, and it is free of defects that could cause to risk children in care. The house has a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a functional phone.

Licensee provides breakfast, lunch, and snacks for children. Licensee provides diapers and bedding for all children which she washes at the end of every week. LPAs observed cribs in to be in good repair and free of any objects or loose materials, with proper fitting sheets. Licensee properly logs fire drills and maintains records with the last drill being done on January 13, 2025. LPAs reviewed children’s files and staff records. Children’s files were all found to be complete, Licensee’s CPR/first aid expires 5/2025. Licensee’s Mandated Reporter Training is current with an expiration date of 9/2025.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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: www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with the Licensees 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 the Licensee 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.

Continued on page 3 >>>>

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOJABAEI, SOROOR	FACILITY NUMBER: 214005033
	VISIT DATE: 01/29/2025

NARRATIVE

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Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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/process.

During the exit interview, the LICENSEE, Soroor Nojabaei, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

No deficiencies were cited during today’s visit. See LIC 9102-TV for technical violation today for physical plant.

A notice of site visit was given and must remain posted for 30 days.
An exit interview was conducted, and the report was reviewed with the licensee, Soroor Nojabaei.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jaclyn Naves
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC809 (FAS) - (06/04)

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