Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618345
Report Date: 07/24/2018
Date Signed: 07/24/2018 10:35:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MAZLOOM, ZIBAFACILITY NUMBER:
343618345
ADMINISTRATOR:MAZLOOM, ZIBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 984-1626
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 3DATE:
07/24/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ziba MazloomTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Amie Randa met with licensee Ziba Mazloom for an unannounced annual inspection. The facility operations Monday-Friday from 7:00am-6:00pm. LPA toured all areas of the home that are accessible to the children and observed care and supervision, a current roster of children, capacity and ratio. Today’s census was three preschool aged children. Also present in the home was the licensee's husband who has been fingerprint cleared. LPA confirmed that all adult residents residing or working in the home have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan.

Off-limit areas include first bedroom, laundry room and garage; licensee requested to add the second room as on-limits. LPA inspected the room and did not observe any hazards.
Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There are no bodies of water on the property. LPA observed a locked gun safe located in an off-limits area of the home and the ammo was stored separately.

LPA observed current CPR and First Aid certificates that expires on 11/2020. LPA observed that poisons are locked and that fire extinguisher, smoke detector and carbon monoxide detector meets regulation. Fireplace is and inoperable during day care hours, cleaning materials, hazardous items and medications are all inaccessible to children. LPA observed a Fire Drill Log and the licensee is conducting fire drills at least every six months. There is a working telephone, toys appear to be in a safe condition and the home appears to be clean and orderly.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2018
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MAZLOOM, ZIBA
FACILITY NUMBER: 343618345
VISIT DATE: 07/24/2018
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LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access formsLPA advised the licensee that it is her responsibility to stay up-to-date and informed in regards to new regulations.

LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against Measles, Pertussis or Influenza. LPA conducted file reviews and observed that all staff are in compliance in regards to the Immunization Regulation.

LPA advised the licensee on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com. LPA observed the licensee has completed the training.

LPA also discussed the Smoking Probation Regulation (AB 1819-Smoking Prohibition), the Nutritious Beverage Act and the Incidental Medical Services (IMS) policies with the licensee. The facility is not currently providing IMS. If the licensee plans to provide IMS in the future she can refer to: 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: www.ada.gov/childqanda.htm

LPA advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood and practiced. She stated she uses porta cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping.

No Title 22 Deficiencies were observed in the areas that were evaluated. LPA read this report to the licensee; she stated that understands today’s inspection. Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2018
LIC809 (FAS) - (06/04)
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