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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313187
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:26:34 PM

Document Has Been Signed on 11/05/2024 04:26 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GHANBARZADEH, DONYAFACILITY NUMBER:
304313187
ADMINISTRATOR/
DIRECTOR:		GHANBARZADEH, DONYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 963-2323
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
11/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility. LPA met with licensee, Donya Ghanbarzadeh. There were 3 napping children present of whom two were under 24 months old.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During a complaint investigation and interviews, LPA found out that Adult # 1 (A1) has been taking care of children for few days on occasions. A1 admitted A1 provided care and supervision for few days for Child # 1 (C1) at the home day care on 11/11/2023.

"Overnight Care" means care being provided to children anytime between the hours of 6:00 pm and 6 am. Care provided during the day and overnight combined shall not exceed 24 Horus from the time the child entered into care.

In the areas that were evaluated, the following deficiency was observed of the California Code of Regulations, Title 22, Division 12 on this inspection. Please see next page LIC 809D for detail of deficiency.
A notice of site visit was given to licensee, Donya Ghanbarzadeh and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to post will result in Civil Penalties of $100.00.

Exit interview conducted and report was reviewed with the licensee, Donya Ghanbarzadeh.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
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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Document Has Been Signed on 11/05/2024 04:26 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 11/05/2024 at 08:36 AM
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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
102352(o)

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 "Overnight Care" means care being provided to children anytime between the hours of 6:00 pm and 6 am. Care provided during the day and overnight combined shall not exceed 24 Horus from the time the child entered into care. This requirement was not evidenced by: During a complaint investigation,
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The licensee agreed to send a statement that she is aware of this section of Title 22 Regulations regarding overnight care at her family child care home. The statement will be sent to LPA on or before 11/8/2024.
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interviews, A1's disclosure, and reviewing documents, LPA found out that (A1) has been taking care of children for few days on occasions. A1 admitted A1 provided care and supervision for Child # 1 (C1) at the family childcare for three days on 11/11/2023.
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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:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2024


LIC809 (FAS) - (06/04)
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