Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204302
Report Date: 05/30/2019
Date Signed: 05/30/2019 12:55:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FAHID, MARYAMFACILITY NUMBER:
304204302
ADMINISTRATOR:FAHID MARYAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 738-1061
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:14CENSUS: 5DATE:
05/30/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maryam FahidTIME COMPLETED:
01:10 PM
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An inspection was conducted at the facility by Licensing Program Analyst (LPA) Stacy Torrence. LPA met with Maryam Fahid who guided analyst on a tour of the facility inside and outside. Also present was Licensee’s Assistant, Shahla Rastvan. There were five children present. Licensee has ten children enrolled. Licensee has a current children’s roster available. Licensee states that two adults live in the home. Operation hours less 24 hours, Monday to Saturday. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
This is a one-story home which consist of six bedrooms, three bathrooms, kitchen, dining room, living room, family room (Fireplace; screen, inaccessible), front yard, detached garage, and back yard(fenced). Off limit areas are: detached garage and living room. The daycare area was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medication, and hazardous items that can pose a danger to children. Per licensee there are no weapons or firearms in the facility. The pool in the backyard was gated and met regulations. There are age appropriate toys and equipment for ages served. Fire/disaster drill log was reviewed. Outdoor play area is the back yard which was gated, and licensee stated staff are always present in the backyard when children are outside playing, there are safe and age appropriate toys for children to use. The required fire extinguisher (2A10BC), smoke detector, and carbon monoxide detector were in operable condition. First Aid kit was complete. Licensee and Assistant had a current CPR/First Aid card with an expiration 06/19. Children's records: parents' rights and California School Immunization Record were reviewed.
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
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FAHID, MARYAM
FACILITY NUMBER: 304204302
VISIT DATE: 05/30/2019
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Licensee has proof of immunization against pertussis; however, need to confirm with her doctor regarding her measles immunization. Licensee provided LPA a written statement refusing the flu vaccine because of health reasons. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee does not have proof of completing the Mandated Reporter Training. LPA advised Licensee that a Lead Brochure will be provided to her via email.

During this inspection, there was no deficiency cited per CA Code of Regulations Title 22. Licensee received a Technical Assistant Advisory Note for not completing the required Mandated Reporter Training and a Technical Violation Advisory Note for measles immunization.

Exit interview was conducted. Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019
LIC809 (FAS) - (06/04)
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