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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314044
Report Date: 10/18/2023
Date Signed: 10/18/2023 11:27:32 AM

Document Has Been Signed on 10/18/2023 11:27 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SHAHRAMNEJAD, ELHAMFACILITY NUMBER:
304314044
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
10/18/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Shahramnejad, Elham. LicenseeTIME COMPLETED:
11:45 AM
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LPA Trinh conducted an unannounced case management inspection on Oct 18, 2023. LPA met with licensee Shahramnejad, Elham, and toured the facility. At the time of inspection there were 4 children present.

All areas identified on the facility sketch were inspected, including but not limited to, off-limit areas. This is a three-story town home with 3 bedrooms, 3 full bathrooms, a Living room, dining room area, and kitchen which are on the 2nd floor. The 3 bedrooms are on the 3rd floor. The daycare area is at the bottom of the town house.
Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation, and heating.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has designated 3rd level of the home, which has two bedrooms, and two bathrooms, and the second floor with kitchen and attached garage, living room, and dining room and balcony as off limits on the 2nd level.

Areas Designated for Daycare activities: Parents and children shall enter the home, through the main entrance door, leading to the 1st floor by using the stairs. The applicant has designated the down-the-stairs room for daycare children. There is one full bathroom, and small kitchen, and two patios on this level of the house. The designated daycare area is one room which is for eating, playing, napping & reading, and daycare activities. This room was observed to have age-appropriate activities and educational items for enrolled children. There is a low-level queen size bed in the corner of this room which may be used for napping older children (Preschool age). There are two pack-and-play for the use of children under 2 years of age. Bedding is provided by the applicant. Applicant shall provide ongoing supervision during nap time.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
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: SHAHRAMNEJAD, ELHAM
FACILITY NUMBER: 304314044
VISIT DATE: 10/18/2023
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The LPA mention and go over the form about safe sleep for children to licensee. That is including infant sleeping plan and 15 minutes document. Licensee stated no smoking, no baby walker, no sausage chair, no trampolines, and any other items that fall into the category are not permitted in the facility.

At the end of the comer of living room (day-care), there is playpen, licensee designated for storage of toys for the day-care children.

The licensee has a cell phone to use for childcare. LPA informed the licensee that the cell phone must always remain on the premises during hours of operation 6:00 a.m.-5:00 p.m. from Monday – to Friday. The licensee stated that she provides breakfast, lunch, and snacks. The license stated if children have allergies depending on allergy, she will substitute the food, or parents will have to bring the food depending on the allergy. The licensee stated that the home is free from smoking during hours of operation. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible by child safety locks. Poisons/Hazardous items are not stored on-site, and none were observed.

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by law to post the following:

Facility License (LIC 203), Waivers (if applicable), Notification of Parent’s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). ). A Notice of Site Visit (LIC 9213) must be posted 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SHAHRAMNEJAD, ELHAM
FACILITY NUMBER: 304314044
VISIT DATE: 10/18/2023
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LPA reviewed the Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831. LPA advised the applicant to report to licensing any unusual incident or child absence that threatens the physical or emotional health or safety of any child or any changes to hours and days of operation and for any changes to the facility, including on/off limit areas and change in phone number

LPA reviewed with licensee requirements of Disaster Preparedness drills (documented every 6 months). The LPA advised of the Affidavit Regarding Liability Insurance (LIC 282) if did not purchase liability insurance and to maintain the form in the children's files, and the Car Safety Seat pamphlet was discussed and provided to the applicant.

The licensee has completed the Mandated Reporter Training for self and 03/2024. Department website form was given to download forms, Title 22 regulations, and training on-line at http://www.ccld.ca.gov. The licensee has registered to obtain quarterly updates and notifications from the Department. Child Care Advocate contact information: [email protected]. was provided. LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment. A copy of “A Child Care Providers Guild to Safe Sleep” was provided to the applicant: English:

LPA discussed the safe sleep regulations with the applicant 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. LPAs also informed the applicant 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.



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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
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: SHAHRAMNEJAD, ELHAM
FACILITY NUMBER: 304314044
VISIT DATE: 10/18/2023
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The applicant was given a pamphlet on Lead Exposure and was discussed with the provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chapter Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdfAppeal Rights and the appeal rights process was discussed with the applicant. The applicant was informed all appeals must be in writing and received by the licensing office within 15 business days.

An exit interview was conducted and the report was reviewed with the applicant. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

The Small Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection. In the event additional requirements are needed, the applicant will be notified.

Appeal rights were provided, and an Exit Interview was conducted with applicant Shahramnejad, Elham.

The operation hours are from 6:00 am to 5:00 pm Monday through Friday for ages 1 year – 7 years.

This report ends here.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC809 (FAS) - (06/04)
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