304313187-7-16-2019-06-CC-MMAK-BE5VAM-20190716161611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313187
Report Date: 07/16/2019
Date Signed: 07/16/2019 04:16:17 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:	GHANBARZADEH, DONYA		FACILITY NUMBER:	304313187
ADMINISTRATOR:	GHANBARZADEH, DONYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 963-2323
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY:	14	CENSUS: 6	DATE:	07/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Licensee		TIME COMPLETED:	04:45 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	Pg 1 An annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. Present in the house was the licensee, Donya Ghanbarzadeh. Present were also licensee's two minor daughters over the age of 10 years old. Census was taken. There were a total of 6 children of whom all the children were under two years old. Currently there is one other adult live in the house besides the licensee. Review of adults' records on today's date indicates that all adults live in the house or individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The children's area was inspected. There is a gate separates the off limit area from children's area. Children's area has age appropriate toys and equipment for children. The licensee was not operating within the licensed capacity. The floor plan was verified. Off limits areas are made inaccessible by means of baby gate, locks, and child proof knobs. Back yard is all fenced. There are no climbing structure or slides in the back yard. There is a trampoline for children's use which is all fenced inside the children's area. Licensee follows the trampoline guidelines. There in no body of water observed. The licensee pediatric CPR/First Aid certification is current. Items which could pose a danger to children were not accessible to children. Poisonous items were not observed during today's inspection. There is carbon monoxide detector in the house, The smoke detector was tested. Appropriate fire extinguisher is in the home. The licensee has a current roster of children in care. Emergency Disaster drill log within the past six months was available. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. Continue on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GHANBARZADEH, DONYA	FACILITY NUMBER: 304313187
	VISIT DATE: 07/16/2019

NARRATIVE

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Pg 2
Incidental Medical Services (IMS) was discussed with the licensee. There are no children with medication at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm .

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov
A copy of child care provider's guide to safe sleep pamphlet and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative on the last inspection.
An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the licensee today.

Notice of Site Visit was posted. Facility representative 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. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

In the areas evaluated, the following deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12 (Section 102416.5(a) ration and capacity for having 6 infants today.

Upon receipt, licensee shall post and provide copies of this report to parents/Guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee may use LIC 9224. Exit interview was conducted.

Exit interview was conducted in Farsi language.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GHANBARZADEH, DONYA	FACILITY NUMBER: 304313187
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/17/2019 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. Licensee is caring for six children of whom all were infants. The license for large family child care home is maximum of four infants. Licensee is operating over capacity.	1 2 3 4 5 6 7	Licensee said she will operate the day care in accordance to ratio and capacity of the large family child care home license. Licensee will reduce the number of children to four infants at any time. Licensee said she will submit the plan she will implement to ensure compliance with staffing ratio and capacity.
	8 9 10 11 12 13 14	Infants are children under 24 months old. This requirement was not evidenced by LPA's observation today. Licensee failed to meet the licensing regulations by having six infants in her care. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	The plan of correction is due to our office by 7/17/2019.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

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