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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495173
Report Date: 09/16/2025
Date Signed: 09/16/2025 03:25:21 PM

Document Has Been Signed on 09/16/2025 03:25 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VAHID FAMILY CHILD CAREFACILITY NUMBER:
197495173
ADMINISTRATOR/
DIRECTOR:		ALI VAHIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 818-4343
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/16/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Ali VahidTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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On 9/16/25, at 2:20 PM, Licensing Program Analyst (LPA) Tatiana Bickham conducted an unannounced Plan of Correction (POC) Visit. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee Ali Vahid, who guided the LPA on a tour of the facility. There were 12 day care children (3 infants) present during today’s inspection. LPA also observed 1 additional staff present at the time of this inspection.

During the Plan of Correction (POC) visit conducted on 8/25/25, the following deficiencies were issued:

Type B- 102417(g)(5)/ Bodies of water
Type B - 1596.8662(b)(1) / Infant Safe Sleep documentation.
Type B - 1596.8662(b)(1) / Mandated Reporter Training.
Type B - 102425(j)(2)(D)(c) / Infant Safe Sleep.
Type B- 1597.622(a)(1)/ Proof of immunization's.
Type B- 102417(g)(1)/ Fire extinguisher shall be service or purchased.


All deficiencies had a due date of 9/8/25.

102417(g)(5)- Licensee has not filled or placed a gate around the water fountain. Licensee filled first half of the fountain with cement blocks. Licensee did not fill the other two levels of the fountain. LPA informed Licensee all three levels of the water fountain needs to be filled with mulch, dirt, or flowers, or a 5ft gate that is self-latching, self-closing and opens away from the bodies of water needs to be installed. LPA informed

Page 1.
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Tatiana Bickham
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VAHID FAMILY CHILD CARE
FACILITY NUMBER: 197495173
VISIT DATE: 09/16/2025
NARRATIVE
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Licensee he cannot place a tarp over the fountain.

1596.8662(b)(1)- Licensee provided LPA with proof of 15 minute safe sleep documentation.

1596.8662(b)(1)- Licensee provided LPA copy of Mandated Reporter certificate.

1597.622(a)(1)- Licensee provided proof of vaccination against Pertussis for assistant but not for himself.

102417(g)(1)- Licensee provided proof of purchase for fire extinguisher.

102417(g)(4)- Licensee needs to place a gate around the rose bushes.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Ali Vahid, Licensee, and appeal rights were provided.

Page 2.
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Tatiana Bickham
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/16/2025 03:25 PM - It Cannot Be Edited


Created By: Tatiana Bickham On 09/16/2025 at 03:06 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: VAHID FAMILY CHILD CARE
FACILITY NUMBER: 197495173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2025
Section Cited
CCR
102417(g)(1)

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(g) The home shall be free from defects or conditions which might endanger a child... (4) ...other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by: LPA observation of rose bush with thorns accessible to children in care. This poses a potential health and safety risk to children in care.
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Licensee shall either cut All rose bushes or place a gate around them by the date listed.
Type B
09/30/2025
Section Cited
CCR
102417(g)(5)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a
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Licensee shall either place a 5ft fence that is self-latching, self-closing, and opens away from the body of water around the fountain or will fill the fountain with dirt, mulch, or flowers on all levels.
Licensee shall provide documentation the LPA by the date listed.
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pool cover or by surrounding the pool with a fence.
This requirement is not met as evidenced by:
LPA observation of water fountqain that does not have a fence or is filled. This poses an potential health and safety risk to children in care.
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Type B
09/30/2025
Section Cited
HSC
1597.622(a)(1)

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(1) ... a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.... This requirement is not met as evidenced by:
Based on LPA observations, Licensee does not have proof of Pertussis vaccination.
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Licensee shall provide proof of Pertussis vaccination to LPA by the date listed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Tatiana Bickham
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2025


LIC809 (FAS) - (06/04)
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