343624113-3-3-2022-03-CC-ATIY-CC6P9E-20220303100701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624113
Report Date: 03/03/2022
Date Signed: 03/03/2022 10:07:12 AM

Document Has Been Signed on 03/03/2022 10:07 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:	SHAREGHI, MEHRI		FACILITY NUMBER:	343624113
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	03/03/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Shareghi, Mehri		TIME COMPLETED:	10:15 AM

NARRATIVE

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On Thursday, March 3, 2022, at approximately 8:30 AM, Licensing Program Analysts (LPAs) Alize Tillery and Amanda Sutter met with Applicant Mehri Shareghi for the purpose of an announced pre-licensing inspection. During today’s visit, applicant and another adult resident was present in the home. Adult #2 has a pending criminal record clearance. Applicant plans to operate Monday – Friday from 7:30 AM to 5:00 PM.

A health and safety inspection was conducted inside and outside the home. The home includes 2 bedrooms, 1 bathroom, living room, play area, kitchen, laundry room, basement and backyard. Off-limit areas will include the: room #2 and basement. Applicant understands that children may never enter these off-limit areas.

There is a fireplace connected to the tv stand that does not work. Toxic and hazardous items are inaccessible to children and out of children’s reach. Sharp knives are stored in the kitchen in a locked drawer, out of children’s reach. Children’s medications will be stored above the refrigerator, out of children’s reach. A functioning smoke detector, carbon monoxide detector and a full 2A10BC fire extinguisher was observed in the home. LPA discussed the required licensing postings and recommended COVID19 posters.

Applicant Mehri Shareghi has completed the required Preventative Health and Safety course and the Lead Poisoning Prevention on 01/15/2022. Applicant has a current CPR and First Aid Certificate that expires 1/24/2024. Applicant completed the Mandated Reporter Training; Applicant’s certificate which expires 9/28/2022. Applicant understands CPR and Mandated Reporter training is to be renewed every two years. There are no weapons in the home. There are no bodies of water on the premises. Applicant was encouraged to maintain supervision at all times. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

Report continues on LIC809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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: SHAREGHI, MEHRI	FACILITY NUMBER: 343624113
	VISIT DATE: 03/03/2022

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Mehri Shareghi.

Applicant needs to complete the following prior to licensure:

- Lock the basement door (accessible from the backyard)
- Remove the hazardous items from the backyard area
- Adult #2 fingerprint clearances pending
- Licensing postings

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

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