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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314324
Report Date: 04/18/2024
Date Signed: 04/18/2024 09:46:30 AM

Document Has Been Signed on 04/18/2024 09:46 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PARVIZIAN, SHAHRZADFACILITY NUMBER:
304314324
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Applicant Shahrzad ParvizianTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 4/18/2024, at 9am, Licensing Program Analyst (LPA) Anna Chan conducted an announced, in-person Pre-Licensing continuation inspection for a new Small Family Child Care home. LPA met with Applicant, Shahrzad Parvizian and led a tour of the home. The purpose of the visit is to complete Title 22 requirements.

The pressure gauge on the 3-A:40-B:C fire extinguisher indicates fully charged, as indicated on the pressure gauge. The fire extinguisher type 3-A:40-B:C must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed. There is a fire extinguisher in the kitchen. Smoke and carbon monoxide detectors were tested and are operable.

LPA observed the gas tanks in the side yard were kept on a combination locked storage container that made inaccessible to children in care.

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The Small Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection. In the event additional requirements are needed, the applicant will be notified.

A license will be issued after a final file review.

Appeal rights were provided. Exit interview conducted and report was reviewed with the applicant Shahrzad Parvizian


(End of Report)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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