197700974-10-9-2025-12-CC-MRIA-DMAQGP-20251009120952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700974
Report Date: 10/09/2025
Date Signed: 10/09/2025 12:10:28 PM

Document Has Been Signed on 10/09/2025 12:10 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	SAFARLOU FAMILY CHILD CARE		FACILITY NUMBER:	197700974
ADMINISTRATOR/ DIRECTOR:	ADRNEH SAFARLOU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 261-5060
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/09/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Adrneh Safarlou, Applicant		TIME VISIT/ INSPECTION COMPLETED:	12:20 PM

NARRATIVE

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On Thursday, October 9, 2025, Licensing Program Analyst (LPA) Mayra Rivera conducted an announced pre licensing inspection and met with applicant Adrneh Safarlou who granted access and guided LPA Rivera on a tour of the facility. The applicant is requesting a large family childcare license. Fire clearance approved on August 16, 2025.

Family members residing in the home have been discussed with applicant and are cleared. Operating hours will be Monday to Friday from 7:00 a.m. to 6:00 p.m. and care for children ages 0-13.

This facility is a two-story home that consists of 4 bedrooms, 3 bathrooms, kitchen, living room, family room (daycare area), attached garage and backyard.

Areas off limits to children include- All second floor which includes 3 bedrooms, 2 bathrooms. First floor kitchen, living room, dining area and attached garage. LPA observed the bottom stairs to be barricaded with an installed gate.

Areas accessible to children include- family room (daycare), bathroom located in the daycare room and back yard.

LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed central AC/heater, and vents located on the ceiling. LPA observed an installed gate in front of the fireplace to prevent children access. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA observed cots to be in good condition. LPA did

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAFARLOU FAMILY CHILD CARE	FACILITY NUMBER: 197700974
	VISIT DATE: 10/09/2025

NARRATIVE

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not observe cribs or play yard. LPA informed applicant if she plans on providing infant care, she must have a play yard or crib to with a mattress with a fitted sheet and free from bumper pads, pillows, blankets, toys, and hanging items.

LPA Rivera observed cleaning compounds items stored in the garage. LPA observed two locks on the door and informed to place a chain lock on top of the door to prevent older children from opening the garage door. LPA observed knives and sharp objects to be stored in top cabinet making it inaccessible to children to reach. LPA observed an installed gate between daycare room and kitchen to prevent children access to the kitchen. LPA observed the electric outlets to have covers. For water drinking, LPA observed a water dispenser and disposable cups. Applicant stated she will be providing the meals for the children. LPA informed applicant food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated.

LPA Rivera entered the bathroom and observed the toilet, hand washing sink, and hand soap. LPA did not observe hazard materials and observed the bathroom to be in good condition.

LPA Rivera asked applicant if there are any pets, poisons, firearms, weapons, or bodies of water. Applicant stated she has in-ground pool and no pets, no firearms, and no weapons. LPA did not observe pets, poisons, firearms, or weapons, and observed an in-ground pool.

Applicant was informed that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition/firing pins must be stored separately.

LPA observed an in-ground pool in the backyard. LPA observed the pool to be fenced with approved American Society for Testing and Materials (ASTM) mesh and measured the height from the ground up to the top of the fence to be 5.0 ft high and fence does not obscure the pool from view. The fencing is not all around. The sides have neighbors brick walls, and the back is also fenced. The openings of the railings (door area), LPA measured and observed the openings to be 3 inches wide. LPA observed the door to swing away from the pool and the self-latching device is no more than 6 inches from the top of the gate. LPA measured and observed the bottom door opening to be 3.5 inches.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAFARLOU FAMILY CHILD CARE	FACILITY NUMBER: 197700974
	VISIT DATE: 10/09/2025

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LPA informed applicant about new AB-2866 Pool safety: State Department of Social Services regulated facilities. LPA observed an ASTM in water pool alarm, 13 ft body hook, life ring with diameter of 20 inches and labeled as approved by the United States Coast Guard. LPA provided safety measures daily log for applicant to complete daily. LPA reminded applicant, the mesh fencing must not be removed and no ladders or any climbing equipment near the fencing. LPA informed applicant, if in the future the fencing needs to be replaced, applicant will need to contact the department to notify about the change.

LPA Rivera observed 1A10BC fire extinguisher located in the kitchen. LPA informed applicant the required is 2A10BC. LPA observed a dual carbon monoxide detector and smoke alarm located in the daycare room. LPA tested the dual carbon monoxide and smoke alarm. LPA Rivera heard the sound and is it operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the kitchen. For ill isolation, applicant stated will use a corner of the daycare.

LPA Rivera inspected the play outdoor area that will be utilized by children for safety, comfort, and cleanliness. LPA observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA observed play equipment to be age appropriate and did not observe high climbing equipment. LPA observed the side gates to closed and lcoked.

LPA observed applicant Adrneh Safarlou American Heart Association Pediatric First Aid/ CPR certification dated August 19, 2024, and Health and Safety certification dated April 5, 2025, and applicant has proof of immunization against Pertussis, MMR, and Influenza declination. The applicant has completed the child abuse mandated reporter training dated August 19, 2024.

Applicant Adrneh Safarlou stated she plans to care for infants 0-24 months old. LPA informed applicant of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA provided the LIC 9227 Individual Infant Sleeping Plan and Safe Sleep Log form.

During the inspection, applicant posted LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and child car seat law poster.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAFARLOU FAMILY CHILD CARE	FACILITY NUMBER: 197700974
	VISIT DATE: 10/09/2025

NARRATIVE

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The following was also discussed with the applicant:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2 Pediatric First Aid and CPR: American Heart Association or American Red Cross or Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR must be present. Certification must be renewed every two years.

3. Applicant was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

4. In the absence of the licensee 80/20 a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

5. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

6. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated

7. The fire extinguisher type 2A-10BC must be serviced annually or as often as ne cessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

8. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAFARLOU FAMILY CHILD CARE	FACILITY NUMBER: 197700974
	VISIT DATE: 10/09/2025

NARRATIVE

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9. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

10. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

11. Smoking is prohibited in the family childcare home.

12. Children and staff records must be maintained and updated as needed and be available for review by the Department.

13. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, 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. The licensee and all adults working with children have proof of immunizations.

14. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

15. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

16. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

17. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

18. Dog(s) and/or pets are recommended to be isolated from children in care.

19. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAFARLOU FAMILY CHILD CARE	FACILITY NUMBER: 197700974
	VISIT DATE: 10/09/2025

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Applicant Adrneh Safarlou was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant Adrneh Safarlou provided proof of control of property.

The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149)

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

Review of records to be maintained - Family Child Care Homes LPA reviewed with applicant Adrneh Safarlou, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA Rivera explained in detailed to applicant LIC 9221 Parent Consent for Administration of Medications and medication chart, LIC 9040 Child Care Facility Roster, LIC 624 Unusual Incident Report, LIC 9227 Individual Infant Sleeping Plan, Safe sleep practices, safe sleep log, the California Car Seat Law Changes (effective February 2018), Effects of Lead Exposure, Shaken Baby Syndrome, and Sudden Infant Death Syndrome (SIDS). Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant Adrneh Safarlou and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep,as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAFARLOU FAMILY CHILD CARE	FACILITY NUMBER: 197700974
	VISIT DATE: 10/09/2025

NARRATIVE

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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.

On this date June 3, 2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant Adrneh Safarlou was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Subscribe to CCLD important information - Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Corrections needed: Fire extinguisher 2A10BC a chain lock for garage door. Applicant has 30 days to make the corrections. Due date 11/9/25.

Exit interview conducted and report was reviewed with applicant Adrneh Safarlou.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

LIC809 (FAS) - (06/04)

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