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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493782
Report Date: 10/08/2024
Date Signed: 10/08/2024 04:38:14 PM


Document Has Been Signed on 10/08/2024 04:38 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
EL SEGUNDO CC NORTH, 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:
10/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Leila FathiaslTIME COMPLETED:
04:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tatiana Bickham conducted an unannounced Case Management Visit to this facility. At time of arrival 2:00 PM Licensee was not present. LPA met with Licensee's assistant Leila Fathiasl. While conducting an alternate visit at Jahandideh Family Child Care on 10/8/24, the following deficiencies were observed.

At 2:00 PM LPA Bickham was refused entry into the home. LPA identified self and stated purpose of the visit but was denied entry by Licensee's assistant. At 2:05 PM LPA was asked to come back tomorrow because Licensee was not here, per assistant no one is allowed into the home. LPA called the Licensee, number goes to voicemail and voicemail is full. LPA also sent a text message to the Licensee regarding the denial of entry, no response. At 2:30 PM LPA was allowed to enter the home.

At 2:30 PM LPA Bickham observed 11 children in care with 1 staff.

The following deficiencies were observed to be in violation of California code of Regulations, Title 22, (refer to 809D).

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.

Page 1.
SUPERVISOR'S NAME: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Tatiana BickhamTELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
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


Document Has Been Signed on 10/08/2024 04:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/09/2024
Section Cited
CCR
102391(a)

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Inspection Authority of the Department
Any duly authorized officer, employee, or agent of the Department shall... enter and inspect any place providing personal care, supervision, and services at any time,
This requirement is not met as evidence by
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Licensee will print Inspection Authority regulation for staff and will have staff sign as proof that they read and understand the regulation. Licensee will send signed copies to LPA by date listed.
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Based on observation staff did not comply with the section sited above in that the staff did not allow LPA to enter the home after identifying self which posed a
health, safety or personal risk to children in care.
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Type A
10/09/2024
Section Cited
CCR102416.5(e)

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If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home...
This requirement was not met as evidenced by:
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At 2:33 PM another staff arrived, putting the facility back in ratio. Licensee will ensure there is another assistant at all times or will not have more than 8 children present if there is no assistant.
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LPA observation of 1 staff supervising 11 children. This poses an immediate health and safety risk to 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: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Tatiana BickhamTELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JAHANDIDEH FAMILY CHILD CARE
FACILITY NUMBER: 197493782
VISIT DATE: 10/08/2024
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensee's assistant Hanyeh Rahmati and Appeals Rights provided.

Page 2.
SUPERVISOR'S NAME: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Tatiana BickhamTELEPHONE: (424) 301-3023
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3