<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492885
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:28:56 AM

Document Has Been Signed on 06/13/2022 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:JAVADI FAMILY CHILD CAREFACILITY NUMBER:
197492885
ADMINISTRATOR:JAVADI, FARZANEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 254-0753
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Farzaneh Javadi- LicenseeTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/13/2022 Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection and was met by Licensee, Farzaneh Javadi. Also present at the facility was licensees adult son and 7 children. Days and hours of operation are Monday through Friday 7am through 5:30pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room (play area and activity centers), the hallway, room leading to the backyard patio, bathroom attached to the room leading to the backyard patio are accessible to children. All other rooms are off-limits and made inaccessible by use of closed doors with child proof safety door knobs. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons (pesticides) are kept in a locked storage area in the off limits bathroom. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

LPA observed a fireplace in the living room that will not be used during day care hours, blocked with a wooden-brown cover and a wooden desk making it inaccessible to children in care. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 254-0753.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. There is a detached garage that is completely off limits as well. Children have access to the backyard from the one room designated for their use, into the patio area and the rest of the yard. Capacity as specified on the license is being maintained.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JAVADI FAMILY CHILD CARE
FACILITY NUMBER: 197492885
VISIT DATE: 06/13/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. LPA discussed the Mandated Reported regulation and the requirement to complete every two years. Licensee and licensees son will complete the required Mandated Reporter Training (AB1207) and submit proof of completion certificate to LPA via email on or before 06/20/2022. Licensee and licensees son pediatric CPR/First Aid expires on 08/18/21. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3