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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313893
Report Date: 05/05/2023
Date Signed: 05/11/2023 12:25:39 PM

Document Has Been Signed on 05/11/2023 12:25 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MIRFATTAHI, SEYEDEH ZAHRAFACILITY NUMBER:
304313893
ADMINISTRATOR:MIRFATTAHI, SEYEDEH ZAHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 545-4057
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Zahra MirfattahiTIME COMPLETED:
04:30 PM
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A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Mrs. Bootorabi and M. Magana. LPA's were greeted by licensee Zahra Mirfattahi.

During today’s inspection, LPA observed children in the living room area and the licensee stated that this was the main area of care. The LPA observed two bouncers, a bassinet, 2 large cribs and 4 play pens.

Bouncer 1 & 2 were removed upon entry after LPA advised licensee that it is not permitted to have bouncers.

LPA Bootorabi discussed safe sleep regulations with licensee. LPA consulted licensee about sheets, and items in the areas of sleep for infants.

LPA Bootorabi provided a consultation on the use of high chairs and cribs for infants/children in care.

LPA provide copies of infant safe sleep regulations, CPSC Flier for safe Sleep, Infant Safe Sleep Regulations, and Frequently Asked Questions for Safe Sleep in Farsi.

The LPA asked Licensee if there are any updates to be made for LIC 279, LIC 610, or LIC 999. Licensee stated there were updates on her name and will be providing an updated LIC 279. LPA provided a copy for licensee. Licensee stated she would be reviewing the documents with her assistant #2 and submitting changes.

During today's inspection the licensee stated she had a friend visiting. Base on the licensee statement the friend visits frequently on Friday's and weekends. The licensee was reminded that adults should be finger printed.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/11/2023 12:25 PM - It Cannot Be Edited


Created By: Araceli Bootorabi On 05/05/2023 at 10:18 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: MIRFATTAHI, SEYEDEH ZAHRA
FACILITY NUMBER: 304313893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2023
Section Cited
CCR
102425(A)

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Upon the provider’s observation that the infant is capable of rolling
from their back to their stomach and stomach to their back, the
provider shall fill out Section D of the Individual Infant Sleeping Plan ...
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The licensee stated that she would not do it again.
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Based on record review of the LIC 9227 infant #1 is not able to roll on her back. LPA observed infant #1 on her stomach while being in a bassinet which poses a immidiate health & safety risk to persons in care.
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Type A
05/05/2023
Section Cited
CCR102425(b)

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Cribs or play yards shall be free from all loose articles and objects.
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The liensee stated that she will not be placing items in the cribs again and removed items from the bassinet.
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Based on observations by LPA the licensee had 2 large wooden cribs with articles inside. A baccinet was observed with an infant (C2) with a blankets, hanging articles, diaper, a bottle and wipes which poses a immidiate health & safety risk to persons in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023


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Document Has Been Signed on 05/11/2023 12:25 PM - It Cannot Be Edited


Created By: Araceli Bootorabi On 05/05/2023 at 11:11 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: MIRFATTAHI, SEYEDEH ZAHRA
FACILITY NUMBER: 304313893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2023
Section Cited
CCR
102416.5(a)

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The capacity specified on the license shall be the maximum number of children for whom care may
be provided at any one time.
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Licensee stated one child is going to be picked up and she will be calling the other parents to pick up the children so she could be in ration.
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Based on observations and census count the licensee was out of ration. The licensee did not have an assistant and was not operating within capacity which poses a immidiate health & safety risk to persons in care.
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Type A
05/05/2023
Section Cited
HSC1596.846(b)

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A baby walker shall not be kept or used on the premises of a child day care facility.
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The licensee removed them during the visit. The licensee stated she would not have them moving forward.
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Based on LPA's observations upon entry the LPA observed 2 bouncers in the area of care which poses a immidiate health & safety risk to persons in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023


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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, SEYEDEH ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 05/05/2023
NARRATIVE
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Criminal Record Clearance Consultation

· All individuals subject to a criminal record review under Health and Safety Code Section 1596.871 shall before working, residing, or volunteering in a licensed facility:

· Obtain a California clearance or a criminal record exemption as required by the Department or (2) Request a transfer of a criminal record clearance as specified in Section 102370(j) or (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside, or be present at the facility.
· Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.
· Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days.
· The Department may assess civil penalties for continued violations as permitted by Health and Safety Code Section 1596.99.

LPA provided Guardian Information and website info:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Video: https://ccld.childcarevideos.org/family-child-care-providers/background-check-requirements-for-caregivers/

LPA offered interpretations to the licensee. Licensee agreed to the interpretation at 10:33 am. At this time the LPA reviewed infant safe sleep regulations with licensee. Licensee was consulted on the bouncers that were observed upon LPA(s) entry of the home. The licensee was consulted on the bassinet observed in the living room and used for infant in care. Licensee was consulted on reporting requirements to Child Care Licensing Office. The licensee was also reminded that all adults over the age of 18 shall be background checked. The licensee was also consulted on the ratio/capacity.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, SEYEDEH ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 05/05/2023
NARRATIVE
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The LPA reviewed the children’s DOB on the children’s roster while having interpretation on the phone . The licensee and LPA discussed the ages of the children and capacity regulations. The LPA demonstrated the Capacity Regulations Sheet to the licensee. The licensee was operating with 4 infants and 3 toddlers without an assistant.

The bassinet was observed to have a folded quilt over the mattress and no fitted sheet. The bassinet contained diapers, wipes, pants, Vaseline, a bottle, and articles attached to the side of the bassinet. The bassinet and bouncer (1&2) was placed in the front yard by licensee and licensee stated she was throwing them away.

The licensee understands they 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 for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR,First Aid, and mandated reporter training.



The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: CCR 102425(A), CCR 102425(b), CCR 102416.5(a), HSC 1596.846(b)

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day and shall provide them to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt of the Proof of Correction for 30 consecutive days.

An exit interview was conducted with Zahra Mirfattahi. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the regional manager at
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, SEYEDEH ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 05/05/2023
NARRATIVE
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the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
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