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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313893
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:34:26 PM

Document Has Been Signed on 02/27/2024 02:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MIRFATTAHI, ZAHRAFACILITY NUMBER:
304313893
ADMINISTRATOR:MIRFATTAHI, ZAHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 545-4057
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/27/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee and her assistantTIME COMPLETED:
03:00 PM
NARRATIVE
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A case management inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. LPA met with licensee, Zahra Mirfattahi who let LPA in. LPA also met with licensee's assistant, Tania Casro. LPA observed 6 children of whom two child were under 24 months old who was held by the assistant. Licensee was operating within the licensed capacity as specified on license.
A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Currently there are three adults including the licensee living in the facility. Facility Day care hours of operation is Monday through Friday from 6:30 am-5:00 pm. The licensee stated sometimes there is another adult live on the other side of the outdoor space with a separate entrance from her childcare. The licensee stated that the licensee is taking care of the adult after day care hours. According to licensee the adult who lives on the other side of the backyard is not involved with children at all. The adult is fingerprint cleared.
During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits area is separated by means of baby gate and locks. The childcare area consists of one large room which is separated from the kitchen area by a baby gate. There is a sliding glass door separated from this large room that all the children's items are stored. The back yard is also for children's use. The crib the infant is sleeping in is free from any items and blankets. Older children sleep on cots. The bathroom for children is located in the same children's area. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger to children were not readily available to children they were stored inaccessible to children. There is a diaper changing table in the corner of the children's day care area that has a high raise bar on the sides. LPA
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 02/27/2024
NARRATIVE
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reminded the licensee that children shall not be left unattended on the changing table during diaper changing.

The outdoor area was fenced. LPA observed high climbing structure with slide and two swings on the grass. There were some wood chips on the bottom of the slide. Licensee stated she takes rubber mats with her to put around the falling zone. The licensee stated she is planning to redo the playground. LPA advised her to send a picture of the new equipment and flooring.
Licensee's roster was reviewed. Fire Drill log was reviewed and the last one was conducted on 2/15/2024. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. LIC 9227 was reviewed. The log for very 15 minutes check on napping children under 24 months old reviewed. (Total of 6 files were reviewed).
The licensee's Pediatric CPR/First Aid certification card is current is expired on May 2023. Required immunization for licensee is complete.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-
CCP. 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: https://www.ada.gov/resources/child-care-centers/.
The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 02/27/2024
NARRATIVE
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Licensee, Zahra Mirfattahi was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee, Zahra Mirfattahi and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed Licensee, Zahra Mirfattahi of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee, Zahra Mirfattahi was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication. (The licensee is already signed up for this purpose).

In the areas that were evaluated, the following deficiency was observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. A notice of site visit was given to licensee, Zahra Mirfattahi and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the licensee, Zahra Mirfattahi.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/27/2024 02:34 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 02/27/2024 at 01:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRFATTAHI, ZAHRA
FACILITY NUMBER: 304313893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2024
Section Cited
CCR
102416(c)

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Personnel Requirement- The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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The licensee stated she has enrolled online for CPR and 1st aid through American Red Cross. She needs to attend the in person training as well. She will send a certificate to show the course is completed to LPA's email address by the due date.
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The above section was not met as evidenced by licensee's CPR and 1st aid card was expired in May 2023. The assistant's card is current but she is not here during the whole operation of the day care. This is a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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