304312123-2-13-2025-06-CC-MMAK-DDUR34-20250213113918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312123
Report Date: 02/13/2025
Date Signed: 02/13/2025 11:39:28 AM

Document Has Been Signed on 02/13/2025 11:39 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SHAHBAZIAN, FARINAZ		FACILITY NUMBER:	304312123
ADMINISTRATOR/ DIRECTOR:	SHAHBAZIAN, FARINAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 400-2955
CITY:	IRVINE	STATE: CA	ZIP CODE:	92603
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	02/13/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:15 AM
MET WITH:	Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:10 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	Page 1 of 4 An Annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. LPA met with licensee, Farinaz Shahbazian and her two assistants, Mina Tavakoli, and Mahsa Asadi Zeidabadi. More children and the 3rd assistant, Soheila Kaviani arrived during inspection. LPA observed 11 children of whom 3 children were under 2 years of age. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there is no other adults and no minor children living in the facility. Facility Day care hours of operation is Monday through Friday from 8:00 am-5:00 pm. During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of locks. The childcare area consists of napping room, one room, family room, living room, dinning area, kitchen, children's bathroom and side yard. Main childcare room is accessed upon entering the home. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger to children were not readily available to children they were stored inaccessible to children, none were observed during inspection. Licensee stated there is no firearm in the facility. There is no pets at the house. There is a French door in the dinning room which leads to the pool in the backyard which is off limits and was observed equipped with 2 locks and alarm on the door. The front yard was separated from the back yard for children's use. Garage is off limit and was locked. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

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

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHAHBAZIAN, FARINAZ	FACILITY NUMBER: 304312123
	VISIT DATE: 02/13/2025

NARRATIVE

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There is an in ground swimming pool in the back yard area in the off limit area. LPA and the licensee, Farinaz Shahbazian toured the in ground swimming pool inside and out and tested the equipment.
The following was observed to make sure the in ground swimming pool meets the new requirement for the new pool safety regulation that went effective as of 1/1/2025. LPA observed the following:
1- Pool mesh fencing met the requirement by mesh fencing of minimum height of 60 inches, and maximum vertical clearance of 2 inches from the ground to the bottom of the enclosure.
2- An access gate that opens away from the pool and is self closing with a self latching, key lockable device placed no lower that 60 inches above the ground.
3- No gaps or voids that can allow the passage of a sphere with a diameter equal to or greater than 4 cinches.
5- Free of handholds or foothold that could enable a child to climb over.
6- An alarm that sound upon detecting an entrance into the water which was compliant by ASTM International Standard F2208. The licensee tested the alarm and was operable.
7- A life ring with a minimum of exterior diameter of 17 inches and was labeled by the United States Coast Guard.
8- A rescue pole was mounted on the wall inside the pool area with a body hook and a minimum length of 12 feet.
9- Daily inspection log was completed.

LPA verified there is a working telephone service (cellular service). Licensee stated, they use the front yard for outdoor play. The outdoor area was fenced and was separated from the side and back yard.

The licensee does have a current roster of children in care. Fire Drill log was reviewed and the last one was conducted on 11/20/2024. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. LIC 9227 was reviewed. The log for very 15 minutes check on napping children under 24 months old reviewed. (Total of 11 files were reviewed).

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHAHBAZIAN, FARINAZ	FACILITY NUMBER: 304312123
	VISIT DATE: 02/13/2025

NARRATIVE

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The licensee's, and one assistant's Pediatric CPR/First Aid certifications are current.
Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and her assistant were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. Licensee's and her assistants' mandated reporter training certificates are current.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-
CCP. 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: https://www.ada.gov/resources/child-care-centers/.

The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
Licensee, Farinaz Shahbazian 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.Continued on page 4

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHAHBAZIAN, FARINAZ	FACILITY NUMBER: 304312123
	VISIT DATE: 02/13/2025

NARRATIVE

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

Licensee, Farinaz Shahbazian 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.

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 athttps://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication. (The licensee is already signed up for this purpose).

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. A notice of site visit was given to licensee, Farinaz Shahbazian and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Farinaz Shahbazian.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

LIC809 (FAS) - (06/04)

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