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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500048
Report Date: 07/22/2021
Date Signed: 07/22/2021 02:02:59 PM

Document Has Been Signed on 07/22/2021 02:02 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:SALEHI, HOSSAIFACILITY NUMBER:
394500048
ADMINISTRATOR:SALEHI HOSSAIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 665-8592
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
07/22/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Hossai SalehiTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Christopher Jackson met with licensee Hossai Salehi for an unannounced random annual inspection and toured areas of the two-story home accessible to children in care. Off-limit areas include entire upstairs, garage, and laundry room. The census included seven children in care. There were four infants and three toddlers in care during today's inspection. Also present was licensee’s adult daughter and teenage son during today's inspection. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances.

LPA observed CPR/First Aid certificates which expire on 04/23. LPA discussed licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed four children’s files during today's inspection. LPA observed the files to be kept according to Title 22 regulations. LPA discussed the requirement for fire drills. LPA observed a fire drill was conducted on 7/21. LPA reminded licensee that at least once every six months fire drills shall be conducted and documented. LPA observed Fireplace which was screened. LPA observed that cleaning materials were inaccessible. LPA observed that there were no hazardous items accessible to children. LPA observed knives to be kept out of reach of the children in care. LPA observed weapon in the home stored according to Title 22 regulations. The fire extinguisher, smoke detector and carbon monoxide detector meet regulation. Toys appear to be safe. The backyard is fenced and gated. There are no bodies of water observed.

During the inspection LPA reviewed COVID-19 guidance and conducted a technical assistance tour of the facility to incorporate Department of Public Health safety protocols for operating during the pandemic. LPA discussed posting requirements and facility operations including sanitation and pick up/drop off procedures.

Report Continues on 809-C

SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2021
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: SALEHI, HOSSAI
FACILITY NUMBER: 394500048
VISIT DATE: 07/22/2021
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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.

LPA discussed licensing requirements, including SB 277 (no longer accepting religious beliefs for immunization's) and SB 792 pertaining to immunization requirements for staff. In addition LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. In addition LPA discussed the infant sleep plan. LPA discussed the requirement for all infants 12 months and under to have a completed copy of LIC 9227 in the child's file. LPA provided a copy of LIC 9227 for licensee during today's inspection.

LPA discussed the Mandated Reporter Training with licensee and reminded licensee of the requirement to renew their training every two years. Volunteers are encouraged but not required to take the training. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

LPA checked facilities fees and confirmed that it is up to date.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws and regulations childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies were cited during today's inspection. LPA reviewed report with the licensee and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
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