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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623240
Report Date: 08/27/2021
Date Signed: 08/27/2021 03:42:26 PM

Document Has Been Signed on 08/27/2021 03:42 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ESKANDARI, SIMAFACILITY NUMBER:
343623240
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
08/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Sima EskandariTIME COMPLETED:
04:00 PM
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At 2:45 on Friday, August 27th, 2021, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Sima Eskandari, for the purpose of a required 1 year inspection. A risk assessment for COVID-19 was conducted via telephone prior to entry into the facility. Licensee's daughter was also present during inspection and provided translation assistance. All individuals subject to criminal background review have obtained criminal record clearance. Hours of operation of the facility are from 7:30 a.m.-5:30 p.m., Monday thru Friday. At time of arrival, LPA observed a census of 3 infant children.

A health and safety inspection was conducted in all areas accessible to children. During today's inspection, Licensee requested to make previously off limits Master bedroom and bathroom, guest bedroom, and guest bathroom on limits spaces. LPA inspected rooms and bathrooms for hazards. Licensee provided updated Facility Sketch form LIC999. Off limit areas will now consist of daughter's bedroom and living room. Licensee acknowledged that children must never enter these off limits areas.

LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. Toxic and hazardous items are inaccessible to children. Fireplace in the home is barricaded with a gate to prevent access by children. Outdoor play space is fenced in the back yard.

At 3:10 p.m., LPA reviewed children’s files and observed immunization records and signed Family Child Care Home Notification of Parents' Rights in children's files. A current roster is being maintained and fire and disaster drills are documented. Current in person EMSA CPR and First Aid certification was verified and expires April 4th, 2023.

Report continued on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2021
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: ESKANDARI, SIMA
FACILITY NUMBER: 343623240
VISIT DATE: 08/27/2021
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This provider is currently not providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

LPA observed 2 pack and play cribs and 1 bassinet. LPA observed infant napping logs and an infant sleep plan in each infant child’s file.

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/childqanda.htm.

LPA verified that the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and shall 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 three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.



In the areas that were evaluated, no deficiencies were observed at the time of the inspection.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
LIC809 (FAS) - (06/04)
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