304311916-1-17-2025-06-CC-OMEA-DD22Z8-20250117164956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304311916
Report Date: 01/17/2025
Date Signed: 01/17/2025 04:51:19 PM

Document Has Been Signed on 01/17/2025 04:51 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	NESHATFAR, SHAHNAZ		FACILITY NUMBER:	304311916
ADMINISTRATOR/ DIRECTOR:	NESHATFAR, SHAHNAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 923-0494
CITY:	IRVINE	STATE: CA	ZIP CODE:	92614
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 4	CENSUS: 2	DATE:	01/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Shahnaz Neshatfar		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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 1/17/2025 an annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Olivia Meza. Upon arrival, LPA met with Licensee Shahnaz Neshatfar and was provided a tour of the home. There were two other residents with one preschool one infant.L icensee stated that facility day care hours are Monday through Friday 7am to 6pm. During today’s inspection, LPA Meza and licensee toured the inside and outside areas of the facility. Off limits areas are made inaccessible by means of safety gate blocking off living room area and door covers for off limit areas. The childcare area consists of the living room, Kitchen, Backyard and bathroom. There was a carbon monoxide, smoke detector, and fire extinguisher that met statutory requirements. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. During today’s inspection LPA verified there is a working (cellular) phone service. Licensee was instructed that children must be supervised at all times. Children’s records for 4 children during LPA’s inspection were reviewed. The licensee’s Pediatric CPR/First Aid certification is not current and expired on 1/11/2025. Licensee stated they have appointment on 1/24/2025. The most recent Emergency disaster drill was conducted on 9/19/2025 and is conducted every six months. LPA observed and reviewed LIC 9227 Individual Infant Sleeping Plan in children’s files. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 (continue to page 2)

Martha Malane	TELEPHONE: (310) 740-3022
Olivia Meza	TELEPHONE: (714) 293-9315
	DATE: 01/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NESHATFAR, SHAHNAZ	FACILITY NUMBER: 304311916
	VISIT DATE: 01/17/2025

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

(page 2)
as an additional resource. LPA also informed licensee 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. Safe sleep 15 minute log was reviewed, sleep plan was also reviewed for all infants under 12 months of age.

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/.

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. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

CCLD website www.cdss.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. Licensee does/does not have lead training Certificate. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

LPA discussed the safe sleep regulations with licensee 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.
( Continue to page 3 )

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Olivia Meza	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NESHATFAR, SHAHNAZ	FACILITY NUMBER: 304311916
	VISIT DATE: 01/17/2025

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

( Page 3 )
LPA also informed licensee 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 was informed of the MyChildCarePlan.org website; 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.

Based on LPAs (observations, record reviews and interviews) the following violation(s) was/were observed is/are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1. See LIC 809 D for violations cited:1 Type B.

Appeal Rights were explained, and licensee was provided a copy. All appeals must be in writing and received by the Regional Office within 15 business days.

Notice of site visit was provided and must be posted for 30 days. Exit interview was conducted.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

end of report

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Olivia Meza	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 01/17/2025 04:51 PM - It Cannot Be Edited

Created By: Olivia Meza On 01/17/2025 at 04:18 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: NESHATFAR, SHAHNAZ	FACILITY NUMBER: 304311916
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


	Deficient Practice Statement
1 2 3 4	102416 ( b ) Personnel requirements (b) This requirement was not met as evidenced by the licensee did not ensure that there was at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation. Based on LPA interview and record review there was no adult staff that has a current CPR and First Aid Certification on file which poses a potential risk to children in care.
	POC Due Date: 01/31/2025
	Plan of Correction
1 2 3 4	Licensee stated that they understand to obtain a First Aid and CPR certification course before expiration date. Licensee stated that they will send proof to the department of current CPR and First aid certification via email to olivia.meza@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Martha Malane

TELEPHONE: (310) 740-3022

LICENSING EVALUATOR NAME:

Olivia Meza

TELEPHONE: (714) 293-9315

LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

LIC809 (FAS) - (06/04)

Page: 4 of 4