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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300658
Report Date: 04/17/2024
Date Signed: 04/17/2024 02:01:10 PM

Document Has Been Signed on 04/17/2024 02:01 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ZAEIMIYAZDI FAMILY CHILD CAREFACILITY NUMBER:
376300658
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
04/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Somayeh ZaeimiyazdiTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On date and time listed above, Licensing Program Analyst’s (LPA’s) Keely Messerschmidt and Kelly Gerth arrived to the facility to conduct a Case Management visit to increase the license capacity from a small family child care home to a large family child care home. A fire clearance was granted for an increase of capacity on 3/26/2024. LPA's met with licensee Somayeh Zaeimiyazdi and toured the facility, and the following was observed and/or discussed:

· Normal days and hours of operation are: Monday through Friday 7:00 am – 5:00 pm.

· Off-limit areas include: kitchen, living room, master bedroom, bedroom 2, master bathroom, bathroom 1, laundry room and garage.

· All hazardous items are stored inaccessible to children.

· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· No stairs in home

· Clean, safe, and age-appropriate toys are provided.

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted.

· No bodies of water are present at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ZAEIMIYAZDI FAMILY CHILD CARE
FACILITY NUMBER: 376300658
VISIT DATE: 04/17/2024
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·Licensee's Pediatric CPR and First Aid Card expires on 9/30/25
· Mandated Reporter certificate expires on 7/11/25

Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.


Licensee was reminded that all adults 18 and over, living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Large Family Child Care Home License will be submitted for approval with a maximum capacity of 12, or 14 with parent notification.



An exit interview was conducted, and this report was reviewed with the Licensee Somayeh Zaeimiyazd. Appeal rights were discussed and provided during the exit interview. A copy of this report and Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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