304311972-3-22-2023-06-CC-ABOI-CQ6LYX-20230322091104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304311972
Report Date: 03/13/2023
Date Signed: 03/22/2023 09:11:51 AM

Document Has Been Signed on 03/22/2023 09:11 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:	IZADPANAH, ZOHREH & SADAGHIANI, MAJID		FACILITY NUMBER:	304311972
ADMINISTRATOR:	IZADPANAH & SADAGHIANI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 387-4805
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY:	14	CENSUS:	DATE:	03/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Zohreh Izadpanah		TIME COMPLETED:	12:00 PM

NARRATIVE

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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Mrs. Bootorabi and Lopez R. . An Entrance Checklist (LIC 126) was provided to the licensee upon arrival.

Census upon entry:
Infants: 3
Children Over Two: 0
Adults Working Directly with Children: 2
Other Adults: 2
The licensee was operating within the licensed capacity as specified on the license. The Facility Day care hours are 7:30 am - 5:30 p m, Monday through Friday

Upon arrival, the LPA verified that the following documents were posted in a prominent, publicly accessible area; License, PUB 394 Notification of Parents’ Rights, and LIC 9148 Earthquake Preparedness. The licensee was in compliance upon review.

During today’s inspection, LPA observed the children being fed breakfast by the licensee and the Assistant #1. Three children were observed sitting in feeding chairs in the family room.

The LPA and licensee toured the facility inside and outside. The facility sketch (LIC 999) was verified. Areas stated to be off-limits by the facility sketch were made inaccessible by child safety gates and closed doors. Sharp items in the kitchen were observed to be put away out of reach of children. Licensee was advised to put glass items in places children cannot open the cabinets or be at reach.

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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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Document Has Been Signed on 03/22/2023 09:11 AM - 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. The infant cribs contained bumbpers, unfitted blankets, additional blankets, stuffed animals and other toys attached to the crib.
	POC Due Date: 03/27/2023
	Plan of Correction
1 2 3 4	Licensee removed the additional items in the crib durring today's visit. She was consulted on safe sleep regulations. Licensee will submit pictures of cribs to demonstrate compliance.

Type B

Section Cited

CCR

102425(b)(2)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. (2) Bumper pads shall not be used. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the infant cribs contained bumbper in the cribs during today's inspection.
	POC Due Date: 03/27/2023
	Plan of Correction
1 2 3 4	Remove bumbpers and maintain cribs free of additional articles. Licensee will send pictures of cribs to demonstrate compliance. Licensee removed bumpers during today's visit.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/22/2023 09:11 AM - 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above.
	POC Due Date: 03/27/2023
	Plan of Correction
1 2 3 4	The licensee will provided proof of completion in two weeks.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above.
	POC Due Date: 03/27/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of immunization records. Licensee was able to print immunizarion records during today's visit.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
	VISIT DATE: 03/13/2023

NARRATIVE

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The licensee tested the carbon monoxide and smoke detector during today’s inspection. Both were functioning. .

Detergents, cleaning compounds, medicines, and other items which could pose a danger are not readily available to children and 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.

The licensee stated the children's primary care and play areas consist of the livingroom, backyard and dinning, family room area. The home has age-appropriate toys for the ages served.

Records Reviewed

The LPA requested to review the LIC 610A Emergency Disaster Plan, Verification of Disaster and Fire Drills, and LIC 9040 Facility Roster. The licensee was in compliance. The licensee was in compliance upon inspection and LPA reminded the licensee of the importance of keeping documents up to date to be in compliance consistently.

Personnel Records

The LPA requested the licensees and present personnel records (1 of 1 assistants) for review. The following documents were reviewed; CPR First Aid Certification for (Licensee , 11/2025), LIC 9052, Immunization records, TB clearance and LIC 9108, and a Mandated Reporter Training Certificate 07/2021

The licensee's assistance was not in compliance. The following documents were not found in file: immunization records and mandated reporter trainer. The licensee was able to provide immunization records for assistant during today's inspection.

The licensee(s) did no have LIC 9180, or immunization records. The licensee was able to meet compliance upon visit. A copy of immunization was printed and provided.

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
	VISIT DATE: 03/13/2023

NARRATIVE

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CPR & FIRST AID

Family daycare homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility and shall be present with the children when children are offsite from the facility for facility activities.

Licensee was in compliance.

Mandated Reporter Training Health and Safety Code (HSC) section 1596.8662 requires all licensed child care providers, administrators and employees of licensed child care facilities, and applicants for family child care home licenses to complete child abuse-mandated reporter training and to renew the training every two years.

For additional information and resources on Child Abuse Mandated Reporting, please see the CDSS Resources for Providers. For all other questions, please contact your Local Regional Office.

https://mandatedreporterca.com/

Children’s Records

The LPA requested 3 children’s records of children present during today’s inspection from the licensee. The LPA reviewed files to verify the following documents Immunization Records, LIC 700 Identification and Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. The licensee was in compliance upon review.

Facility License File Review

The LPA asked Licensee if there are any updates to be made for LIC 279, LIC 610, or LIC 999. The licensee updated the following documents: LIC 279. Page 3

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
	VISIT DATE: 03/13/2023

NARRATIVE

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Safe Sleep

The LPA requested to review LIC 9227 Individual Infant Sleeping Plan and Individual Infant Sleep Logs. The LPA and Licensee toured the infant napping areas and observed blankets, stuffed animals, crib bumpers, and attatched toys to the cribs.

The licensee documents infants checks every 15 minutes and described what to look for checking for infants. Licensee is not in compliance with Safe Sleep Regulation at this time. The LPA provided a consultation to support license become in compliance. Licensee removed the bed bumpers and additional blankets from the cribs during today's inspection. Licensee was advised to remove toys and hanging items from cribs.

During today’s inspection, the licensee and LPA discussed the following:

- Stay up to date with LIC 9227 and discuss with parents any new changes

- Ensure 15 min checks are conducted & logged (The initial of the person checking should be included)
- 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.
- Always place infants on their backs to sleep
- Use only a tight-fitting sheet on the crib or play yard mattress
- Do not hang any items from the crib or above the crib
- Keep all items, including blankets, out of the crib or play yard
- Pacifiers may be used if they do not have items attached to them
- Infants should not be swaddled or have any items covering them while sleeping
- The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.
The following are additional resources.
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
The American Academy of Pediatric https://www.aap.org/en/patient-care/safe-sleep/

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
	VISIT DATE: 03/13/2023

NARRATIVE

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Background Checks

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 3 adults including the licensee and 0 minor child living in the facility. The licensee was reminded that any individuals 18 years or older must have a background check clearance. The licensee was also reminded that any children turning 18 years must obtain a background check to maintain compliance.

Licensee had a worker at the time of inspection. The worker is remodeling her bathroom and is not near the children during business hours. Licensee was reminded to call the office and inform of such changes/ modifications.

Criminal Record Clearance Consultation

· All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
· Obtain a California clearance or a criminal record exemption as required by the Department or (2) Request a transfer of a criminal record clearance as specified in Section 102370(j) or (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside, or be present at the facility.
· Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.
· Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days.
· The Department may assess civil penalties for continued violations as permitted by Health and Safety Code Section 1596.99.
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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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: IZADPANAH, ZOHREH & SADAGHIANI, MAJID	FACILITY NUMBER: 304311972
	VISIT DATE: 03/13/2023

NARRATIVE

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CCLD website www.ccld.ca.gov was provided to licensees to access regulations, updates, and licensing forms.

The licensee was informed of the important updates available at www.ccld.ca.gov and may request to be added to an email list to receive Community Care Licensing Important Notifications from the above website and selecting Receive Important Updates: https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Conclusion

The licensee understands (she/he) 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 for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR/First Aid, and mandated reporter training.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today:

HSC 1596.8662(b)(1)

HSC (1597.622(c)

CCR 102425 (b)

CCR 102425 (b)(2)

Page 6 (end)

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC809 (FAS) - (06/04)

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