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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402110
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:14:24 AM

Document Has Been Signed on 03/30/2022 11:14 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:TAKESHI, EZATFACILITY NUMBER:
073402110
ADMINISTRATOR:TAKESHI, EZATFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 952-4849
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ezat TakeshiTIME COMPLETED:
11:30 AM
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On 3/30/22 at 9:15 AM Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual Inspection at Ezat Takeshi's Family Day Care Home. LPA met with Licensee, Ezat and explained the purpose of today’s inspection. LPA was granted permission to enter the facility. Present in the home were Licensee, Assistant and 5 day care children (3 infants, 2 preschool age). Facility is in compliance with required ratios today. 2 more preschool age children arrived after 1 hour, bringing census to 7 children. Days and hours of operation are Monday - Friday from 7:30 am - 6:30 pm. All adults have Criminal Background Check Clearances, TB clearance and signed Criminal Record Statements LIC508.

LPA toured the INDOOR spaces of the home with Licensee. In Use Areas: Garage converted into Playroom, 1 Bedroom (nap) and 1 Bathroom (in hallway near kitchen) Off Limit Areas: Living room, Kitchen/Dining, all other 2 bedrooms and 2 bathrooms
Garage has been converted into Playroom, with an exclusive side entrance, separate from main entrance to home. Children walk through the Kitchen/Dining area to reach the bathroom. There were no accessible dangerous items observed in the kitchen/dining areas. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. Children were engaged in various activities under the supervision of the Licensee and Assistant. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is sanitary, orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. There are no stairs inside the home. The Licensee has a working telephone in the home.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TAKESHI, EZAT
FACILITY NUMBER: 073402110
VISIT DATE: 03/30/2022
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LPA observed a fully charged fire extinguisher and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. LPA reviewed a current Children Roster. Last fire/disaster drill was completed 3 months ago in Dec 21-Jan 22. Postings - Parent Rights Poster PUB394, Facility License, observed posted on a wall. The Licensee states that she does not transport children. She supplies snacks and meals to the children. Food storage area was observed to be clean. LPA discussed Healthy Beverages Act with the Licensee. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

OUTDOOR space was inspected. In Use Areas: Small play yard fenced off from Large Backyard Off Limit Areas: Large Backyard used by personal family
The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. Heavy structure was secured to the ground. The yard was fenced and there were no bodies of water.

FILE REVIEW: Children, Licensee, Assistant files reviewed, contained all required documents. Licensee's certifications for CPR/First Aid expire on 8/23.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times.

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
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TAKESHI, EZAT
FACILITY NUMBER: 073402110
VISIT DATE: 03/30/2022
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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.

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.
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 will submit updated Emergency Disaster Plan LIC610A by end of 4/6/22.

In the areas that were evaluated, no regulatory violations were observed. LPA provided technical assistance on Mandated Reporter training, Fire Drill Log, Sleep Log.
Website for Mandated Reporter Training: www.mandatedreporterca.com

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Exit interview conducted and report was reviewed with the licensee, Ezat Takeshi.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
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