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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624749
Report Date: 01/26/2023
Date Signed: 01/26/2023 10:50:08 AM

Document Has Been Signed on 01/26/2023 10:50 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:SHIRZAD, SILGYFACILITY NUMBER:
343624749
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/26/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Silgy ShirzadTIME COMPLETED:
11:00 AM
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On Thursday, January 26, 2023, at 9:00 AM, Licensing Program Analyst (LPA) Tanya Washington met with Applicant, Silgy Shirzad for the purpose of an announced pre-licensing inspection. During today’s inspection, the applicant and her spouse Ahmad were present in the home. All adults residing in home have criminal record clearances. Applicant plans to operate Monday- Friday from 7 AM to 8 PM. Applicant has notified the landlord of her plan to provide care to children and has received permission from the management of the apartment complex.

A health and safety inspection was conducted inside the apartment. This facility is located on the premises of Sierra Park Town Homes complex. This facility is a two story which has a living room, kitchen, bathroom, dining room, laundry room and fenced patio downstairs. The upstairs contains three bedrooms and one bathroom. Off limit areas will consist of the entire second floor, laundry room and patio. Applicant understands that children may not have access to the off limit areas. Applicant agrees to contact the Licensing office to make changes to on and off limit areas.



Toxic and hazardous items are inaccessible to children and out of children’s reach. Sharp knives are stored in the kitchen in a high cabinet, out of children’s reach. All medications will be stored in the upstairs master bedroom. A functioning smoke detector was observed in the home. Applicant does not have a carbon monoxide detector or a fire extinguisher. She stated that both items will be purchased later on today. All required documents to be posted were provided during the inspection. Applicant stated that she will purchase a board to hang the required posters and send a photo to LPA.

Applicant is enrolled in Preventative Health and Safety course which includes lead poisoning prevention and one hour of nutrition component. Applicant has also completed EMSA certified CPR and First and course, her certificate is valid until 12/4/2024. Applicant is exempt from the Mandated Reporter Training due to language barrier. There are no weapons in the home. There is a pool in the complex which is properly fenced according to Title 22 Regulations. 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: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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: SHIRZAD, SILGY
FACILITY NUMBER: 343624749
VISIT DATE: 01/26/2023
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Applicant 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitting to the Department. 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 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.

An exit interview was conducted, LIC311D, records, postings, and reporting requirements were discussed. LPA discussed personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Prior to licensure the following items must be corrected by 02/26/2023.

- Living room TV adjusted to the wall

- Living room curtain rod must be properly attached to prevent injury

- Parent's Rights poster and LIC610A must be posted near front entry

- Purchase/ install- carbon monoxide detector and 2A10BC fire extinguisher

- Send proof of Preventative Health and Safety Certificate

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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