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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412618
Report Date: 11/05/2024
Date Signed: 11/05/2024 11:47:08 AM

Document Has Been Signed on 11/05/2024 11:47 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PAKIZEGEE FAMILY CHILD CAREFACILITY NUMBER:
197412618
ADMINISTRATOR/
DIRECTOR:		PAKIZEGEE, AFSANEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 614-9050
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
11/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Afsaneh PakizeggeTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 11/05/2024 Licensing Program Analysts (LPA) Judy Laureano and Brittany Lovest conducted an unannounced case management inspection at the above-mentioned facility for the purpose of ensuring that standards are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

LPAs met with Afsaneh “Sepi” Pakizegee, Licensee, and toured the home both indoors and outdoors. LPAs did not observed any children in care. Licensee is requesting to be removed from inactive status as of 11/08/2024.

Licensee confirmed that families will enter the home through the main entrance. Licensee will use the living room space for napping and children will eat in the kitchen area.

The kitchen was observed and inspected. All cabinets were observed with working safety latches. LPAs observed a working fire extinguisher in the kitchen and extra activity space in the back. The kitchen will be used as a walkway to access the back yard and the extra activity space.

Licensee confirmed the following areas are off LIMITS: 2 bedrooms and 2 bathrooms and formal dining room.

Licensee confirmed the following areas for day care use: living room, kitchen area, back yard and the extra activity space. Children will use the 1/2 bathroom located in the back area near the extra activity space.

Licensee’s Mandated Reporter training was taken on 5/10/2024. CPR and First was taken on 10/18/2024. LPAs reviewed the guardian roster and verified that all adults living in the home have a criminal record clearance.

LPAs discussed Safe Sleep Regulations with Licensee and provided the LIC 311D-Records to Keep in Your Family Child Care Home and provided a sample packet.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PAKIZEGEE FAMILY CHILD CARE
FACILITY NUMBER: 197412618
VISIT DATE: 11/05/2024
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The following need corrections before children can be present in the home:

1. Remove the hazardous items near the ½ bathroom.

2. ½ bathroom needs safety latches under the sink cabinet.

3. ½ bathroom needs to be clean and remove the ladder in the space.

Licensee agrees to email pictures of corrections to LPA by 11/8/2024.

No deficiencies were cited during today’s inspection in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1 and California Health and Safety Code.

Upon on receipt of this report, the Licensee shall post the Notice of Site Visit.
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.

An exit interview was conducted, and report was reviewed with Licensee Afsaneh "Sepi" Pakizegee". A copy of this report was left with the Licensee, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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