304314777-9-15-2026-06-CC-MMAK-DXXPEV-20260915111545

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314777
Report Date: 09/15/2026
Date Signed: 09/15/2026 11:16:00 AM

Document Has Been Signed on 09/15/2026 11:16 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:	JAHANVASH, GHAZALEH		FACILITY NUMBER:	304314777
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	09/15/2026
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:15 AM
MET WITH:	Licensee		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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 3 On 9/15/2026, Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection for the purpose of increasing the license capacity from Small Family Childcare Home (Capacity of 8 children) to Large Family Childcare Home (14 children). The LPA met with applicant, Ghazaleh Jahanvash who provided a tour of the home. A review of the Facility Personnel Report Summary indicates the adult residents received caregiver background check clearances or exemptions as required by the Department. Per the applicant, there are three adults including the licensee and no minors living in the home. The licensee was supervising one child upon arrival. Four more children arrived during LPA's inspection. The total number of children reached to 5 children of whom 3 of them were under 24 months old. The licensee is requesting a Large Family Childcare Home License. Per the applicant, operation hours will be Monday through Friday, 7:30 AM- 6:00 PM. Care and supervision will be provided to children ages 0 to 13 years old. For the purposes of licensing, an infant is defined as any child 0 to 24 months of age. All areas on the Facility Sketch LIC999 were inspected, including but not limited to, off-limits areas. The home is a single family home with 4 bedrooms, den, 3 bathrooms, a family room/living room, dinning area, kitchen, storage rooms, and a back yard. The licensee has designated the 3 bedrooms and a den and 2 bathrooms located in upstairs area, living room, dinning area, laundry room, and kitchen as off limit areas. There is a baby gate installed in front of kitchen area, and one installed in front of the entrance to family room. The licensee has designated family room, one bedroom, children's bathroom, and backyard as the day care areas. Children will be eating, doing activities in the family room area and napping in the bedroom located on the downstairs area. There are 3 cribs located in the bedroom for napping of infants which are free from foreign objects, and 5 cots available for older children's napping. Parents provide beddings for their children. There is also a changing diaper table in the room with appropriate bars on all sides. The licensee was reminded not to leave children unattended on the diaper changing tables. Continued on page 2

Thuy Ho
Mahnaz Malek
	DATE: 09/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: JAHANVASH, GHAZALEH	FACILITY NUMBER: 304314777
	VISIT DATE: 09/15/2026

NARRATIVE

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Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation, and heating. The children’s bathroom was observed to be safe and free of hazardous items. The cabinet under the sink in the children's bathroom were free of hazardous items. The designated childcare areas was observed to have age appropriate toys and educational items.

Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant stated that there are no poisons on the premises and LPA did not observe any. There are two dogs form Husky and Pomeranian breeds that they are kept away from day care children. Smoke detector and Carbon monoxide detectors and fire extinguisher were operable.

The back yard are is all fenced at least in 4 feet height. There are appropriate toys and children's equipment for children's play in the backyard area. LPA observed a low height slide and a see-saw located on artificial grass (Turf). There are two exits on the side of backyard that are locked. There are no bodies of water.

The licensee has a current (EMSA approved) Pediatric First Aid and Pediatric CPR certification and a current mandated reporter training certificate.

The licensee was informed of the following documents for having an assistant.
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 (LIC 9188).

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 following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Continued on page 3

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Mahnaz Malek
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

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: JAHANVASH, GHAZALEH	FACILITY NUMBER: 304314777
	VISIT DATE: 09/15/2026

NARRATIVE

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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 Incidental Medical Services (IMS) - Family Child Care Homes.

LIC 311D for required forms in family childcare home and a flyer for large capacity were provided to licensee.

The licensee provided proof of control of property. The licensee has obtained a signed Property Owner/Landlord Consent form (LIC 9149). With this consent, the licensee may be licensed, and operate with a maximum capacity of 14 children.

LPA discussed the safe sleep regulations with the licensee 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. Five children's files were reviewed. They were in compliance. The log for very 15 minutes check on children under 24 months old during nap time were available. Infant Sleeping Plan (LIC 9227) for children under 12 months of age were avialbe on their files.

Licensee, Ghazaleh Jahanvash was informed of the MyChildCarePlan.org website; 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.

Fire clearance approval for Large Family Childcare Home received on 9/9/2026 with the restriction of garage and upstairs usage. The Small Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection. In the areas that were evaluated, no deficiency was cited of the California Code of Regulations, Title 22, Division 12 on this inspection day. A notice of site visit was given and must remain posted for 30 days.

A licence for Large Family Childcare home for a capacity of 14 children will be issued after final review of management. In the event additional requirements are needed, the licensee will be notified. Appeal rights were provided. Exit interview conducted and report was reviewed with the licensee, Ghazaleh Jahanvash in her native language (Farsi).
End of report.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Mahnaz Malek
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

LIC809 (FAS) - (06/04)

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