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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314458
Report Date: 11/14/2024
Date Signed: 11/14/2024 09:54:58 AM

Document Has Been Signed on 11/14/2024 09:54 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:MOKHATAB-RAFIEE, FARIMAHFACILITY NUMBER:
304314458
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
11/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an unannounced case management inspection of this Small Family Childcare Home for the purpose of changing capacity to Large Family Childcare Home. LPA met with licensee, Farimah Mokhatab-Rafiee who provided a tour of the home.
There was one child present. Two more children arrived at the time of inspection. The total children were 3 children of whom 2 were under 24 months old.
A review of the Facility Personnel Report Summary indicates 2 adults live in the home including the licensee. The adult residents received caregiver background check clearances or exemptions as required by the Department. Per the licensee, there are no minor children living in the home.
The licensee is requesting a Large Family Childcare Home license. Per the licensee, operation hours will be Monday through Friday, 8:00 AM- 5:00 PM and extended to 10:00 pm by appointment, and also on Saturday and Sunday from 8:00 am to 10:00 pm by appointment. Care and supervision will be provided to children ages 0 to 4 years old.
All areas on the Facility Sketch LIC999 were inspected, including but not limited to, off-limits areas. The facility is a one story home with 4 bedrooms, 2 bathrooms, a family room, living room/dinning area, kitchen, closet, fenced back yard, and garage.
The off limit areas are living room, dinning room, kitchen, 3 bedrooms, and garage which a sliding door (locked) has separated the day care area from the off limit areas.
The license understands that licensing staff may have access to off-limits areas during inspection visits if necessary.
The childcare areas are family room, one bedroom (bedroom # 1 on the sketch for napping), one bathroom (bathroom is located in the hallway where the bedrooms are. The entrance for day care is from the front yard. Garage is inaccessible to children. The entrance is from out of the house.
The children’s bathroom was observed to be safe and free of hazardous items. The cabinet under the sink in Continued on page 2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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 3
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: MOKHATAB-RAFIEE, FARIMAH
FACILITY NUMBER: 304314458
VISIT DATE: 11/14/2024
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the children's bathroom was free from any hazardous items. The designated childcare areas were observed to have age-appropriate toys and educational items. There were 3 cribs in the napping room and 2 cribs in
the family room which the safe sleep regulations was discussed with licensee. There was one baby swing in the children's area. LPA also observed other sitting equipment for babies to sit in them which was discussed with licensee that these devices are for use of a short time and they shall not be used for napping. LPA discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA reminded the licensee that the bedroom door that children are napping shall not be completely closed unless an adult is in the room at all times. Infants shall be physically checked every 15 minutes during nap time and be logged. (The log for napping children under 24 months old were available).
Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. There are no pets and no fire arms in the facility.
Fire Extinguisher, Smoke detector, and Carbon Monoxide Detectors are available and operable. (Fire extinguisher is placed on a tall shelf by the entrance door inaccessible to children.
Outdoor play activities will be conducted in the backyard. The backyard is appropriately fenced. There are children's slide (3 low height slides) and one swing. The cushioning underneath and around the equipment are grass and sand. No body of water observed.
Children's files were reviewed. The licensee's CPR and 1st aid is current. They were all in compliance.
STAFF FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records as specified in Title 22 Regulations 102416.1, Notice of Employee Rights (LIC 9052), one Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108) per provider, Copy of Pediatric Cardiopulmonary Resuscitation & Pediatric First Aid (CPR & First Aid Certification), Proof of pertussis, measles, and Tuberculosis (TB) vaccines, Proof of influenza vaccine (or documentation of exemption), Proof of Mandated Reporter Training certificate, Copy of Criminal Background Clearance Transfer Request (LIC 9182), Copy of Criminal Record Exemption Transfer Request (LCI 9188).
Capacity Handouts for a Large Family Child Care Home was provided.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The Continued on page 3
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MOKHATAB-RAFIEE, FARIMAH
FACILITY NUMBER: 304314458
VISIT DATE: 11/14/2024
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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

The licensee, Farimah Mokhatab-Rafiee 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.

The licensee 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 at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


The Small Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection.
Fire Department clearance approval for a capacity of 14 children has been received on 11/7/2024.

In the event additional requirements are needed, the licensee will be notified. An updated Large Family Childcare Home license will be issued after final review in the office. Appeal rights were provided.

Exit interview conducted and report was reviewed with the licensee, Farimah Mokhatab-Rafieer in her native language.
End of report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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