304313843-4-29-2021-06-CC-STOE-C2JTX3-20210429150629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313843
Report Date: 04/29/2021
Date Signed: 04/29/2021 03:06:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	TEHRANI, SEPIDEH		FACILITY NUMBER:	304313843
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	04/29/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:11 PM
MET WITH:	Sepideh Tehrani, Licensee		TIME COMPLETED:	01:20 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) Stacy Torrence conducted a case management inspection, in response to licensee’s request for a capacity increase. LPA met with licensee Sepideh Tehrani, who guided analyst on a tour of the facility. Also present during today’s inspection was licensee’s assistant, Naima Sanchez.. LPA Torrence observed six children playing in the designated daycare area. The facility was within licensed capacity and the required ratio. Licensee stated there are currently one adult and two minor children living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. All areas identified on the facility sketch were inspected, including but not limited to, off limited areas. The facility is a single-story home with four bedrooms, two bathrooms, living room, family room, kitchen, dining room, laundry room, attached garage, front yard(not fenced), and backyard fenced. Licensee has designated the family room, master bedroom, two bathrooms, and fenced backyard as part of her day-care. Licensee has designated three bedrooms, living room, kitchen, dining room, laundry room, and front yard as the off-limit areas. Licensee has placed a door at the entrances of the kitchen, which leads to the living room and dining room, ensuring these areas are inaccessible to the children in care. Licensee’s off-limit bedrooms have doorknobs with locks, ensuring these rooms are inaccessible to the children in care. Licensee acknowledged the children may never enter the off-limit areas, during operation hours. The licensee has a cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. The home is kept orderly and clean with heating and ventilation for the safety and comfort of the children. The home provides safe toys, play equipment, and materials.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEHRANI, SEPIDEH	FACILITY NUMBER: 304313843
	VISIT DATE: 04/29/2021

NARRATIVE

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During today’s inspection, the carbon monoxide and smoke detector were operable, and the fire extinguisher in the home meet statutory and State Fire Marshall standards.

There is a fireplace in the facility, which is barricaded by a safety gate. Detergents, cleaning compounds, medicine, and other items which could pose a danger if readily available to children were stored inaccessible to children. Poisons/Hazardous items are not stored on site, and none were observed. There are no bodies of water. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. The licensee stated there are no weapons or firearms on the premises. LPA reminded licensee, that when firearms are present, they must be locked and stored separately from the ammunition. Licensee stated outdoor activity is conducted in the backyard, which is completely fenced and free from hazardous material.

Licensee provides food for children in care. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.

Licensee has completed the required Pediatric First Aid and CPR which expires on 05/16/2022. Lead Poisoning Preventative Course was completed on 10/2020. There are first aid supplies available.

LPA advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

During today’s inspection, the Capacity Handout (Small & Large) was provided to licensee.

LPA discussed how to report any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEHRANI, SEPIDEH	FACILITY NUMBER: 304313843
	VISIT DATE: 04/29/2021

NARRATIVE

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During todays’ inspection, there were no deficiencies cited and licensee was in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

An exit interview was conducted. The report was reviewed and discussed with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

End of Report.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

LIC809 (FAS) - (06/04)

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