Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210319
Report Date: 10/14/2019
Date Signed: 10/14/2019 10:57:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KHODARAHM FCC AKA ANGEL FAMILY CHILD CAREFACILITY NUMBER:
426210319
ADMINISTRATOR:BEHJAT KHODARAHMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 968-7838
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:14CENSUS: 0DATE:
10/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Behjat KhodarahmTIME COMPLETED:
11:10 AM
NARRATIVE
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An annual random was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson who met with Licensee Behjat Khodarahm. The home was toured inside and outside. Licensee stated she has not been operating her day care since July 2018. There is a 2 A10BC Fire Extinguisher on premises. LPA advised the licensee the Fire Extinguisher needs to be serviced or replaced yearly. There is an operating smoke detector and carbon monoxide detector in the home. LPA reviewed “A Child Care Provider’s Guide to Safe to Sleep, Safe Sleep in Child Care, and Effects of Lead Exposure” handout with Licensee. Licensee's CPR and First Aid is current (expires 02/06/2020). LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. Verification has been reviewed for Licensee. Licensee is reminded when she hires a new assistant to obtain verification of immunization. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or may decline by providing a written statement. LPA reminded Licensee that AB 1207 Child Mandated Reporter Training is required to be completed every two years.

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

No deficiencies cited. The "Notice of Site Visit" was posted at the visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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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