Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618989
Report Date: 01/28/2016
Date Signed 01/28/2016 10:57:11 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:SAHRANAVARD, FIROOZEH AND BAGHDADI, KARIMFACILITY NUMBER:
343618989
ADMINISTRATOR:SAHRANAVARD, FIROOZEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 730-0811
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: DATE:
01/28/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Firoozeh SahranavardTIME COMPLETED:
11:10 AM
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1) An unannounced annual/random visit is made today by LPA Richard Jaime. Present at time of visit were licensee and 8 day care children, 2 infants and 6 preschoolers, and an assistant. A tour of the home, inside and outside, as shown on the facility sketch is conducted. Children were spoken to during visit. There are no "bodies of water" or firearms in this home. Poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children, in off limits area. There is a working fire extinguisher, a smoke detector, and there is adequate heating and ventilation for safety and comfort. A clean and orderly home is observed. Safe toys and play equipment are observed. There is a working telephone. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/FA are current with expiration date of 6/13/17. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Children records reviewed. Off-limit rooms are the garage and upstairs bedrooms. Licensee states children do not have access to these areas. Hours of operation are 7:30 am to 5:30 pm Monday thru Friday. Licensee was given incidental medical forms.
Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies are observed today.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Richard JaimeTELEPHONE: (916) 263-5817
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2016
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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