376627890-4-13-2023-51-CC-JREG-CQUPS4-20230413113343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627890
Report Date: 04/13/2023
Date Signed: 04/13/2023 11:33:58 AM

Document Has Been Signed on 04/13/2023 11:33 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MORTAZAVI, SAMAR FAMILY CHILD CARE		FACILITY NUMBER:	376627890
ADMINISTRATOR:	SAMAR MORTAZAVI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 205-3271
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Licensee Samar Mortazavi		TIME COMPLETED:	11:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/13/2023 at 9:30 a.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit for the purpose of an Annual Inspection. During this visit, there were six children in care with Licensee and staff, Taylor Strong. Four of the children are under the age of 2 years. The facility is within ratio and capacity. LPA toured the home. Primary child care areas are the downstairs bedroom for napping w/ attached bath, a portion of the main room, separated by a safety gate and the rear fenced patio. The facility sketch on file is accurate. Off limits areas have been made inaccessible with the use of safety gates. During the walk around at approximately 9:50 a.m., LPA noted a exersaucer and a bouncer in the main room play area and a walker on the patio. LPA explained that these are restricted items and may not be used. LIcensee removed the items from the children's area into the off limits living room upon request at 10:15 a.m. when children started moving from the nap room to the front room. Licensee states that there are no weapons stored in the home or on the property and there are no bodies of water present. The stairs have been made inaccessible with the use of a safety gate. There is no fireplace. The fire extinguisher is full and of adequate size and located in the kitchen on the counter. There is a dual smoke alarm/carbon monoxide detector, located on the ceiling at the base of the stairs that was tested today. There is also another alarm inside and outside of the nap room. The one outside the naproom was tested and operational. The one inside the room was not tested today. Emergency drills are being conducted and logged at least every six months and there is a written Disaster Plan on file. The home is clean, orderly with adequate ventilation and heating. Licensee has provided enough space for the children to eat, sleep and play within the home. Licensee provides all food. The furniture, to include napping materials and children’s toys, books and activities are safe and age appropriate and in good repair. Licensee has checked for recalled items. There is a working telephone and all required forms are posted in

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MORTAZAVI, SAMAR FAMILY CHILD CARE	FACILITY NUMBER: 376627890
	VISIT DATE: 04/13/2023

NARRATIVE

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the nap room. Outdoor play space is fully fenced with age appropriate play equipment and activities in good repair. No hazards were noted. Licensee understands there is no smoking in or around day care areas.

Children’s files were reviewed. LIcensee is missing form LIC 282 for each child - required as she does not hold liability insurance. There are no school age children enrolled. The facility roster was current and complete and is being stored for 3 years. Licensee recently started care last year in September. Licensee's pediatric CPR/FA certificate with National CPR is valid through 1/2025. Staff files were reviewed and found to be current. Licensee is reminded that Mandated Reporter Training certificates are to be renewed every two years at the following website: www.mandatedreporterca.com. Licensee's certificate is valid through 10/24 and her assistant, Taylor's, is valid through 6/24.

LPA discussed the safe sleep regulations with licensee and 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 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. . Licensee is reminded that infants may not be swaddled while in care and walkers, exersaucers, jumpers, bouncy seats, napping portables and drop sided cribs are not permitted for use.

Children will be observed upon entry and throughout the day for signs of illness. An appropriate isolation area has been established for sick children. Reporting requirements for positive Covid-19 results in children or staff were discussed to include contact with County Department of Public Health for guidance (619-692-8499) and Licensing (619-767-2248) to report the unusual incident for THREE or more cases.

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 submitted 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. No services are in place.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MORTAZAVI, SAMAR FAMILY CHILD CARE	FACILITY NUMBER: 376627890
	VISIT DATE: 04/13/2023

NARRATIVE

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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.

Licensee is to be present in the home to ensure children are supervised and reminded that no children are to be left in parked vehicles and car seats are not to use used for sleeping. Capacity limitations were reviewed. LPA discussed California Megan's Law and the website was provided as follows: www.meganslaw.ca.gov

Licensee is advised to sign up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov. Select “Child Care” then “Quick Links” and Quarterly Updates. Select “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and select “subscribe.”

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

LPA conducted child care quality management interview with Licensee. Exit interview conducted and report was reviewed with the licensee, Samar Mortazavi.

See LIC 809D for a Type B deficiency. Two Technical Violations were issued.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/13/2023 11:33 AM - It Cannot Be Edited

Created By: Joelle Redding On 04/13/2023 at 11:10 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MORTAZAVI, SAMAR FAMILY CHILD CARE	FACILITY NUMBER: 376627890
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(10)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the Licensee did not comply with the section cited above in that LPA observed an exersaucer and a bouncer in the main living room play area and a walker on the outside patio. No children were in the equipment at the time of the visit. This poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	LIcensee removed the walker, exersaucer and bouncer today, prior to children occupying the area and while LPA was present. She stated that she will not use this equipment again and anything new that she brings in she will pass by her assigned Licensing Program Analyst to ensure it is appropriate for day care use.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Renesha Askew

LICENSING EVALUATOR NAME:

Joelle Redding

LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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