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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001110
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:34:23 AM

Document Has Been Signed on 11/14/2024 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FARD-RAMEZANI, HOMAFACILITY NUMBER:
414001110
ADMINISTRATOR/
DIRECTOR:		FARD-RAMEZANI, HOMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 835-4662
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 2CENSUS: 0DATE:
11/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:LIcensee, Homa Fard-RamezaniTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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On November 14th, 2024, at 9am Licensing Program Analysts (LPAs) Tapia-Mandujano and Naves conducted an unannounced random/ annual inspection and met with licensee, Homa Fard-Ramezani. Purpose of the inspection was explained to licensee. Present in the facility are licensee. Per licensee, she has not had any children consistent children but does "drop-in care". As of this day, all adults living and/or working in the facility are fingerprint cleared and associated.

Licensee owns home, which is a 4 bedroom, 2.5 bathroom, two level house. Hours of operation are Monday-Friday 9am-5:30pm. Daycare areas are: First Floor: Living Room, Dining area, Family Room, Bathroom #1, and Backyard. OFF Limit areas are: First Floor:Garage, Kitchen (pass through only), Front yard and Entire Second Floor. Off limit areas, including closets, are properly barricaded.

Per licensee, due to not having children enrolled, home is not "fully" set up. LPAs toured the home and pointed out areas that needed to be done to ensure the health and safety of children in care. LPAs observed the Day-care is clean, orderly with a variety of age-appropriate toys for the children. All furniture inspected is in good repair. The applicant has a fully stocked First Aid kit and was reminded to be aware of the expiration on the First Aid Kit. The home has no pools or bodies of water in the home. The home does not have a fireplace that is covered. Per licensee there are no pets in the home. The home has age-appropriate equipment available for children in care. Licensee was reminded that baby walkers, bouncers, jumpers and any other similar items are not to be used for children in care.

There has a fully charged fire extinguisher, A dual smoke alarm and carbon monoxide alarm, and a working telephone. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home. During today's inspection, LPAs reviewed two children files. LPAs reminded licensee about records to be maintained for children, staff, and facility.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FARD-RAMEZANI, HOMA
FACILITY NUMBER: 414001110
VISIT DATE: 11/14/2024
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LPAs reminded Licensees to maintain and updated every years the Mandated reporter training and CPR/First Aid certification. LPA reminded licensee that she should have these certification if caring for children.

All the required posting documentation, such as the facility license, Notification of Parental Rights and have been placed in a prominent area for parents or representatives to review. LPAs reminded licensee that emergency drills must be conducted at least once every six months and shall be properly logged.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee was reminded that all adults 18 and over, 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 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.

LPA discussed the safe sleep regulations with licensee 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 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.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FARD-RAMEZANI, HOMA
FACILITY NUMBER: 414001110
VISIT DATE: 11/14/2024
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Incidental Medical Services (IMS) policy was discussed. Licensee will decide once children are enrolled. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Homa Fard-Ramezani, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 11/14/24.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Homa Fard-Ramezani.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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