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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313152
Report Date: 02/04/2020
Date Signed: 02/04/2020 03:02:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GHARABI, MARYAMFACILITY NUMBER:
304313152
ADMINISTRATOR:GHARABI, MARYAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 861-2510
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:14CENSUS: 10DATE:
02/04/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee, Maryam GharabiTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Cindy Nguyen conducted a Plan of Correction inspection in response to a Type A violation issued on 01/29/2020. During the inspection on 01/29/2020, the facility was issued a type A violation for operating over staffing ratio and capacity with no assistant/licensee is present at a Large Family Child Care Home, then the licensee/assistant shall comply with a capacity requirement for a Small Family Child Care Home.

During today’s inspection LPA observed 3 infants and 7 preschool age children that is being cared for by the licensee and adult assistant, Sania Hashempour. During today’s inspection the facility was operating within its licensed capacity and within compliance of staffing ratios. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance. Children's records were reviewed during today's inspection. In the areas reviewed the children’s files were found to be compliance.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with licensee Maryam Gharabi and assistant Sania Hashempour. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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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