<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371214
Report Date: 07/05/2022
Date Signed: 07/05/2022 12:14:21 PM

Document Has Been Signed on 07/05/2022 12:14 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEPORT-IRVINE SPECTRUM-NORTH CAMPUSFACILITY NUMBER:
304371214
ADMINISTRATOR:KOONTZ, DONNAFACILITY TYPE:
850
ADDRESS:1 TECHNOLOGY DRIVE BLDG. ATELEPHONE:
(949) 427-3968
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 119TOTAL ENROLLED CHILDREN: 119CENSUS: 44DATE:
07/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Karyn Gharib, Business ManagerTIME COMPLETED:
12:30 PM
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
Licensing Program Analyst (LPA) Quinto conducted an unannounced case management visit. After further review, the incident in question did not take place at this facility. The incident in question took place at one of the other facilities. Census was taken and LPA observed 44 preschool children and 10 staff members.

A review of staff records indicates that all facility staff or other individuals who require caregiver background checks do not have criminal record and child abuse index clearances or exemptions. During a case management visit, LPA discovered that an individual: Marayam Derakhshami does not have a criminal background clearance.

The facility will be cited for Criminal Record violation, Type A for Marayam Derakshami, California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101170(e)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. See LIC 809D.

This report cites a Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Business Manager was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2022
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 2
Document Has Been Signed on 07/05/2022 12:14 PM - It Cannot Be Edited


Created By: Mila Quinto On 07/05/2022 at 11:37 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: LEPORT-IRVINE SPECTRUM-NORTH CAMPUS
FACILITY NUMBER: 304371214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2022
Section Cited
CCR
101170(e)(1)

1
2
3
4
5
6
7
101170 Criminal Record Clearance
(e) All individuals subject to a criminal record review... shall prior to working... in a licensed facility. (1) Obtain a California clearance or a criminal record exemption as required by the Department
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Business Manager, Karyn Gharib, sent Maryam Derakshami home and will ensure to obtain the criminal background fingerprint clearance and associated to the facility prior to returning to the facility.
A civil penalty has been assessed.
8
9
10
11
12
13
14
Based on observation and interview, Maryam Derakhshami was present at the facility and did not have criminal background clearance.Business Manager stated today was her first day at the facility. This poses an immediate safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2