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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010251
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:41:37 PM

Document Has Been Signed on 08/23/2023 02:41 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FAIZIAR, MARIA FCCHFACILITY NUMBER:
483010251
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 15CENSUS: 8DATE:
08/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Maria FaiziarTIME COMPLETED:
02:50 PM
NARRATIVE
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During the course of the complaint investigation Licensing Program Analysts (LPAs) Selena Mariani and Mel Augustin conducted an unannounced Case Management visit and met with Licensee (LS) Maria Faiziar for the purpose of delivering deficiencies for operating over capacity and because LS allowed an excluded adult (A1) without an approved criminal record clearance to be present around the children, and for violation of infant safe sleep requirements. Upon LPA's initial arrival to the facility, LPA's took a head count of 13 children which included an infant (C1) under 24 months old in care with LS and one staff (S1). LPAs noted C1 was awake in a play yard inside the converted garage for approximately 20 minutes, then C1 was subsequently moved to a different play yard in the living room. The facility is currently licensed as a small Family Child Care Home and is allowed to care for a maximum of 8 children. Prior to LPAs' departure, multiple children were picked up by parents and/or adult. The facility did not comply with the requirements with staffing ratio and capacity requirements of California Code of Regulation (CCR) 102416.5(a) which indicates the capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

Furthermore, LS did not comply with CCR 102370(d)(1) which requires all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. Interviews conducted with two parents (P1 & P2) and one adult (A2) on 8/23/23 confirmed they witnessed A1 providing care and supervision at the facility. P1 stated when she dropped her child off into care on 8/23/23, A1 accepted her child into care. P2 and A2, validated that A1 was the point of contact and left their child in care of A1. Department records confirmed A1 was an excluded adult and A1 was not allowed to be on site during the facility's operating hours. The facility is in violation of criminal record clearance requirements and thus, an immediate $500 Civil Penalty is being assessed because LS did not ensure A1 obtained criminal record clearance prior to working at the facility. LPAs consulted with LS on requirements on infant safe sleep. LS understood a child may not be left in a play yard if the child is not napping.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: FAIZIAR, MARIA FCCH
FACILITY NUMBER: 483010251
VISIT DATE: 08/23/2023
NARRATIVE
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Facility Representative 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.

A 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. Exit interview conducted and report was reviewed with the licensee. The following violation(s) of California Code of Regulations, Title 22, Division 12, were cited during today's visit. Appeal Rights were provided.


LPAs Selena Mariani and Mel Augustin informed licensee, Maria Faiziar that this report dated 08/23/2023 document(s) two Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Selena Mariani and Mel Augustin informed the licensee to provide a copy of this licensing report dated 08/23/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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Document Has Been Signed on 08/23/2023 02:41 PM - It Cannot Be Edited


Created By: Selena Mariani On 08/23/2023 at 12:27 PM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: FAIZIAR, MARIA FCCH
FACILITY NUMBER: 483010251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2023
Section Cited
CCR
102416.5(a)

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The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirment has not been met as evidence by: Based on LPAs observation of 13 children in care with LS and S1. This posed an immediate health, safety and/or personal rights risk to the children in care.
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Licensee stated she will fix schedule so she will only have 8 children at a time. LS will submit to LPA a written statement explaining why she was over capasity and how she plans to prevent this from happening again. LS also intends to complete LIC9098 and submit completed form to the Department by 8/24/23.
Type A
08/23/2023
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.

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Licensee stated A1 will not come here anymore. LS will submit to LPA a written statement explaining she understands that A1 is excluded and unable to be present at the facility until A1's exclusionary period has expired. LS also intends to complete LIC9098 and submit completed form to the Department by 8/24/23.
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This requirment has not been met as evidence by: Based on LPAs interviews with P1-P2 and A2 cofirming they witnessed A1 providing care and supervision to children at the facility, and thus an immediate a $500 Civil Penalty was assessed. This posses an immediate health, safety and/or personal rights risk to the children in care.
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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:Alexis Hollon
LICENSING EVALUATOR NAME:Selena Mariani
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023


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Document Has Been Signed on 08/23/2023 02:41 PM - It Cannot Be Edited


Created By: Selena Mariani On 08/23/2023 at 12:38 PM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: FAIZIAR, MARIA FCCH
FACILITY NUMBER: 483010251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2023
Section Cited
CCR
102425(e)

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No infant shall be forced to sleep, to stay awake, or to stay in the designated sleeping area.

This requirment has not been met as evidence by: Based on LPAs observation of C1 being left in play yard in garage for approximately 20 minutes. This posses an potential health, safety and/or personal rights risk to the children in care.
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Licensee agreed to watch video clips on infant safe sleep on the Departments transparency web site at CCLD.ca.gov and LS intends to submit a written statement describing her observations on what she learned on the video and submit POC to the Department by 9/6/23.

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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:Alexis Hollon
LICENSING EVALUATOR NAME:Selena Mariani
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023


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