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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409641
Report Date: 03/24/2022
Date Signed: 03/24/2022 10:41:37 AM

Document Has Been Signed on 03/24/2022 10:41 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LASHKARI, KHADIJEH & KHOSROWFACILITY NUMBER:
434409641
ADMINISTRATOR:KHADIJEH & KHOSROW LASHKARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 855-9351
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Khadijeh LashkariTIME COMPLETED:
10:50 AM
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On 03/24/2022 at approximately 9:10am, Licensing Program Analyst (LPA) Sabina Dodoo met with Licensee Khadijeh Lashkari for an UNANNOUNCED ANNUAL REQUIRED INSPECTION for Family Child Care Home. Present for the inspection were the Licensee and her aid Noushin Shabgard Daem who are all fingerprint cleared. Licensee’s husband who is fingerprint cleared (Khosrow Lashkari) was also present and he is a co- Licensee. The total children enrolled are 14 and the census was 6 children at the time of the inspection. There are 2 infants and 4 preschool children. The Family Child Care Home is within ratio. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 7:30am to 5pm.

PHYSICAL PLANT: The Family Child Care Home is two story, 4 bedrooms, 2 bathrooms with an attached garage house. The family room has been converted into an activity play area. The entrance of the Family Child Care Home is the main door of the house where parents ring the doorbell and Licensee picks the child from parent. LPA observed one bathroom located downstairs that is in operable condition for children to use. LPA observed one bedroom used for napping. There are four see through cribs in the room with a changing pad available. LPA observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). All hazardous materials and toxins are kept out of reach from children and are not accessible. This Family Child Care Home has one fully charged fire extinguisher 3A-10- 40 BC, a working smoke detector, a working carbon monoxide, a telephone and a fully stocked first aid kits. The furniture around the activity area and outdoor area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children.

On Limit Areas are: One-bathroom downstairs, the living room, the family room (activity room), the bedroom located on the left side of the bathroom downstairs and the entire backyard.
Off Limit Areas are: Two bedrooms located upstairs, the upstairs bathroom, the kitchen, dining room, and the garage.

FOOD & SNACK: The Licensee provides food, AM and PM snacks and water for the children.


***Continue on LIC 809C***
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LASHKARI, KHADIJEH & KHOSROW
FACILITY NUMBER: 434409641
VISIT DATE: 03/24/2022
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OUTDOOR: LPA Dodoo observed the outdoor play area, which consist of a play structure with a slide that is age appropriate for children to use. The play yard has soft green material all around to absorb falls. The outdoor play area is also fenced all around with secured gates. There are no bodies of water on the premises. There are no firearms on premises.

RECORDS: At 9:30am LPA Dodoo reviewed 3 children’s file and 2 staff files and documented them on LIC 857 and LIC 859. An updated roster was viewed by LPA Dodoo. A copy will be emailed to LPA from Licensee. The staff interview was completed with Licensee Khadijeh Lashkari. Licensees and staff have completed the Health and Safety training and CPR/First Aid is current. Licensees and staff are following the immunization laws and have completed the mandated reporter training. The Licensees has conducted and documented the fire and disaster drills twice a year and the last conducted drill was on March 15th, 2022. All required forms are posted and visible for public view.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children in care currently. If 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

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.

Licensee was reminded that all adults 18 and over working in Child Care Center, 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 Child Care Center. 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.

***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LASHKARI, KHADIJEH & KHOSROW
FACILITY NUMBER: 434409641
VISIT DATE: 03/24/2022
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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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Khadijeh Lashkari). This report shall remain on file for the next 3 years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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