Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210319
Report Date: 04/20/2016
Date Signed 04/20/2016 12:55:43 PM

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: 4DATE:
04/20/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Behjat KhodarahmTIME COMPLETED:
01:10 PM
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(3) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with licensee, Behjat Khodarahm and her assistant. The home was toured inside and outside. The day care area is the main living room, the nap room and the play room. LPA observed age appropriate toys, games, books, tables and chairs. The home is clean and organized. The bathroom is clean and free of toxins.

The backyard is completely fenced, LPA observed age appropriate toys, games, bikes, shade area, play house, garden area, tables and chairs.

The smoke alarm was tested and was found operational. The carbon monoxide was tested and was found operational. The fire extinguisher meets State Fire Marshall requirements, last serviced March 29, 2016.
Licensee conducted and documented safety drills conducted.

LPA reviewed children's record. LPA reviewed children's roster.

Licensee was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed online at www.ccld.ca.gov.

Reporting, posting, and record keeping requirements were discussed. AB 633 and AB 978 explained to licensee. Licensee has been advised that baby bouncers, walkers, exersaucers are not permitted in a licensed family child care home.

Today, no deficiencies were found under Title 22 Division 12.
LPA observed licensee post the Notice of Site Visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2016
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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