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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625049
Report Date: 06/20/2023
Date Signed: 06/20/2023 10:34:05 AM

Document Has Been Signed on 06/20/2023 10:34 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NOORISTANI, MASOUDAFACILITY NUMBER:
343625049
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
06/20/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Masouda NooristaniTIME COMPLETED:
10:40 AM
NARRATIVE
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At 9:15 a.m. on Tuesday, June 20th, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Masouda Nooristani, for the purpose of an announced prelicensing, change of location inspection. Applicant is previously licensed at facility 343623769. Applicant understands that once licensed at new location, old facility will be closed and care cannot continue at that location. Applicant's spouse and one child care child were present during inspection. Facility hours of operation are from 7:30 a.m. - 9:30 p.m., Monday thru Friday.

All individuals subject to criminal background review have obtained a criminal record clearance. 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.

Applicant guided LPA on a tour of the facility. The single story home consists of 4 bedrooms, 2 bathrooms, kitchen, living room, garage and backyard. Off limits areas will consist of son's bedroom, master bedroom/bathroom, and garage. Applicant acknowledges that child care children must not enter these off limits areas of the home, and their own children under 10 years will count toward the childcare ratio when present during operating hours. LPA observed a 2A10-BC fire extinguisher and functioning smoke and carbon monoxide detectors. LPA reviewed the required postings. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. Applicant stated that there are no weapons nor poisons in the home.

Report continued on 809-C.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: NOORISTANI, MASOUDA
FACILITY NUMBER: 343625049
VISIT DATE: 06/20/2023
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There is a pool in the backyard. LPA observed fencing surrounding the pool that is at least 5 feet tall. Gate was only partially self closing. Gate would self close and latch if not open wide and would remain open if open wide. Latch for gate was within 6 inches from the top of the gate. LPA reviewed civil penalties regarding bodies of water citations that can occur once the facility is licensed. Applicant understands that 100% supervision is required around bodies of water or in unfenced areas.

Applicant owns the home and provided proof of control of property via deed. Applicant has completed the required Preventative Health and Safety course. Applicant's current in person EMSA approved CPR and First Aid certification expires 8/27/24. Applicant was reminded that CPR/First Aid certification shall be renewed every two years.

Applicant was reminded that once licensed they shall ensure that children are supervised at all times. Applicant understands that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

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.

The following corrections are required prior to licensure:

1. Pool gate shall be fully self closing and self latching.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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