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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618345
Report Date: 07/27/2022
Date Signed: 07/27/2022 11:50:24 AM

Document Has Been Signed on 07/27/2022 11:50 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MAZLOOM, ZIBAFACILITY NUMBER:
343618345
ADMINISTRATOR:MAZLOOM, ZIBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 990-4894
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ziba MazloomTIME COMPLETED:
12:00 PM
NARRATIVE
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On Wednesday, July 27th, 2022, Licensing Program Analyst (LPA) Kelly Ferrara and Licensing Program Manager (LPM) Natalie Dunaway conducted an unannounced annual inspection and met with Licensee Ziba Mazloom. LPA and LPM observed there were currently nine children in care with the Licensee and an assistant. Facility hours of operation are Monday through Friday 8 AM to 6 PM. LPA and LPM observed proper ratio and capacity was being followed. LPA observed that the facility annual fees are current.
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.

Off limit areas include: Two front bedrooms, laundry room and garage. Licensee stated during today's inspection she would like to make the first bedroom on limits. Licensee acknowledged that children may never enter these off-limit areas. LPA and LPM conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPA observed the proper documents were posted where visible to parents. LPA observed that the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPA observed a 2A-10-BC fire extinguisher which is accessible. LPA observed the smoke and carbon monoxide detectors are functioning properly. The facility has adequate toys that are safe for children to use. The backyard is fenced and LPA observed there were no bodies of water. LPA observed the firearms are stored and locked according to regulations.
LPA observed a current children's roster. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA observed the CPR/1st aide certificate was current, however it did not have an EMSA sticker. LPA observed the Mandated Reporter certificate had expired and Licensee was reminded it must be completed every two years and her assistant must also have it completed.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MAZLOOM, ZIBA
FACILITY NUMBER: 343618345
VISIT DATE: 07/27/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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.

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/inspection-process.

Incidental Medical Services- IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 discussed current COVID guidelines with Licensee and provided technical assistance.

LPA provided the Department’s website WWW.CCLD.CA.GOV, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA advised Licensee of their responsibility to stay current by reviewing PINs on the website.

There were two citations were issued based on today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
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Document Has Been Signed on 07/27/2022 11:50 AM - It Cannot Be Edited


Created By: Kelly Ferrara On 07/27/2022 at 10:56 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MAZLOOM, ZIBA
FACILITY NUMBER: 343618345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of two files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2022
Plan of Correction
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Licensee shall complete the General Training and the Child Care Training on the mandatedreporterca.com website and obtain a current certificate for herself and her assistant. Licensee shall send the certificates to LPA via email by POC due date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2022
Plan of Correction
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Licensee shall complete an EMSA approved 1st Aide/CPR course or an American Red Cross course by the POC due date. Licensee will send a picture of the card as proof to LPA by POC due date or proof of enrollment.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022


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