343622333-6-29-2021-03-CC-ATIY-C4FNR3-20210629104051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622333
Report Date: 06/29/2021
Date Signed: 06/29/2021 10:41:06 AM

COMPREHENSIVE INSPECTION

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:	HASSANVAND, NAHID		FACILITY NUMBER:	343622333
ADMINISTRATOR:	HASSANVAND, NAHID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 715-4687
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95816
CAPACITY:	14	CENSUS: 5	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Nahid Hassanvand		TIME COMPLETED:	10:45 AM

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 June 29, 2021 at 9:45 AM, Licensing Program Analyst (LPA) Alize Tillery and Licensing Program Manager (LPM) Seychelle De Luca met with licensee Nahid Hassanvand for the purpose of an annual required 1 year inspection. Licensee has also requested a change of capacity. The facility’s days and hours of operation are Monday- Friday from 7:30 AM to 5:00 PM. LPA observed care and supervision of 5 children supervised by the Licensee and husband. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety evaluation was conducted in all areas accessible to children. Off limit areas consist of the entire upstairs. The garage is now considered on limits. Licensee understands children may never eat or sleep in the garage as it is not converted or permitted. LPA observed a 2A10BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per licensee, there are no weapons in the home. No children were observed in parked cars. LPA reminded Licensee that water tables are to be empty and only filled when in use. Toxic and hazardous items are inaccessible to children. Safe toys were observed. The stairs are appropriately gated in the home. A sample of children's records were reviewed. Required postings, a current roster, disaster drill log and emergency cards were available for all children. LPA observed recommended COVID19 posters and current guidelines were discussed. Licensee is scheduled to renew her CPR and First Aid certification on July 2022. Continued on LIC809C

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HASSANVAND, NAHID	FACILITY NUMBER: 343622333
	VISIT DATE: 06/29/2021

NARRATIVE

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LPA discussed the requirement of renewing mandated reporter training every 2 years.

Licensee does not currently provide Incidental Medical Services (IMS). For IMS information, licensee was advised to 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 Safe Sleep in Child Care. LPA provided the following link:http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the Licensee to subscribe to the distribution list and receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request.

In the areas that were evaluated, no Title 22 deficiencies were cited. As of today June 29, 2021 facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only; or up to 8 children with no more than 2 infants, with 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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