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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493782
Report Date: 03/10/2020
Date Signed: 03/10/2020 11:49:20 AM

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:JAHANDIDEH FAMILY CHILD CAREFACILITY NUMBER:
197493782
ADMINISTRATOR:MASOUMEH PIR JAHANDIDEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 625-2320
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:14CENSUS: 11DATE:
03/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Licensee-Masoumeh JahandidehTIME COMPLETED:
12:00 PM
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On 03/10/2020 at 10:05 a.m., Licensing Program Analysts (LPAs) Estrada and Escobedo conducted an unannounced visit to the home to deliver an amended LIC 9099-C-Complaint Investigation Report. Upon arrival, LPAs were met by the Licensee. LPAs observed 1 assistant and 11 children, (1 infant and 10 preschool-aged) children in care.

LPAs Escobedo and Estrada observed 2 walkers and 1 exersaucer in the living room and play area of the family child care home. At 10:07 a.m., Licensee was informed that these items were not allowed in the home. Licensee states that one of the items belonged to her daughter. At 10:09 a.m. Licensee moved 1 exersaucer and 2 walkers to the front yard. At 10:38 a.m., Licensee stated that she will throw out the 2 walkers and 1 exersaucer.

At 10:10 a.m., LPAs Escobedo and Estrada verified that Staff 1 had been fingerprint cleared, however, due to a missing number in facility number, Staff 1 had not been assoicated. At 10:30 a.m., Licensee contacted Caregiver Background Check Bureau (CBCB) and was informed that Licensee should submit the letter stating the clearance, along with her facility number to associate Staff 1. Licensee states that Staff 1 began working on 03/06/2020 for 1 hour per day, as Licensee is training her to work with the children. At 10:51 a.m., Staff 1 left the home to gather the following documents, immunization records and mandated reporter certificate.

At 10:30 a.m., Staff 2 arrived at the home. At 11:11 a.m., Licensee informed LPAs Estrada and Escobedo that Licensee does not have the mandated reporter training certificate for Staff 2. Staff 2 is not sure if she has taken the training. Staff 2 will verify if she has the certificate and inform LPA Escobedo and will provide a copy of the certificate, if it is available.

Continued on LIC 812-C
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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 4
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: JAHANDIDEH FAMILY CHILD CARE
FACILITY NUMBER: 197493782
VISIT DATE: 03/10/2020
NARRATIVE
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There were two deficiencies, 1 Type A and 1 Type B, cited during today's visit in accordance with the California Code of Regulations Title 22, Division 12, Chapter 1. See LIC 809-D for additional information.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with the Licensee, Masoumeh Pir Jahandideh, whose signature on this form confirm receipt of these documents.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JAHANDIDEH FAMILY CHILD CARE
FACILITY NUMBER: 197493782
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2020
Section Cited

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102417-Operation of a Family Child Care Home-A baby walker shall not be allowed on the premises of a family child care home...
This requirement is not met, as evidenced by:
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Based on observation and interview, the Licensee did not ensure that baby walkers were kept off the family child care home, which poses an immediate Health, Safety or Personal Rights risk to persons 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: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: JAHANDIDEH FAMILY CHILD CARE
FACILITY NUMBER: 197493782
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2020
Section Cited

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1596.8662-...training for mandated reporter...employee of a licensed child day care facility shall complete the mandated reporter training... and shall complete renewal mandated reporter training every two years...This requirement is not met as evidenced by:
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Based on observation and interviews, the Licensee did not ensure that 2 of 2 staff had proof of mandated reporter training, which poses a potential Health, Safety, or Personal Rights risk to persons 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: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4