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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300064
Report Date: 10/23/2024
Date Signed: 10/23/2024 04:04:18 PM

Document Has Been Signed on 10/23/2024 04:04 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MOOSAVI-TABARSHIYADE FAMILY CHILD CAREFACILITY NUMBER:
376300064
ADMINISTRATOR/
DIRECTOR:		M. MOOSAVI-TABARSHIYADEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 228-7616
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:44 AM
MET WITH:Mashan Moosavi-TabarshiyadeTIME VISIT/
INSPECTION COMPLETED:
04:30 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
On 10/23/24 at 10:44am, Licensing Program Analyst (LPA) Kelli Waters arrived unannounced at the facility to conduct an annual inspection as part of a compliance review. Licensee was not home and LPA briefly spoke to an assistant and adult resident. LPA was not granted access until Licensee arrived at 12:14pm. LPA met with Licensee, Mahsan Moosavi-Tabarshiyade and toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

Facility Review:
• Normal days and hours of operation are: Monday-Friday 7:30am-5:00pm

• Off-limit areas include: kitchen, all bedrooms and all bathrooms on right side of entrance hallway, and backyard and right-side side yard. An area that was previously off-limits and will now be on limits is the dining area. During the inspection, the converted garage space was being used as the main daycare area. The lower daycare, a converted garage space is NOT to be used for any child care purposes until cleared by the Escondido Fire Department and Community Care Licensing. A Type A citation will be issued .

• The facility is licensed to have no more than 14 children as a large FCCH and is operating within the licensed capacity and appropriate ratios. Licensee was present during inspection with 6 children, 2 of which were infants. However, while waiting for Licensee to arrive, LPA observed an uncleared assistant providing care.

• A working telephone is present, and the current phone number is on file. LPA will update facility information with an additional working phone number.

• A fully charged fire extinguisher (2A:10BC) was observed. A smoke detector and carbon monoxide detector were present and tested in both daycare areas by the Licensee during this inspection.

• All hazardous items are stored inaccessible to children

• Toxins are locked and inaccessible to children in care.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelli Waters
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE
FACILITY NUMBER: 376300064
VISIT DATE: 10/23/2024
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
26
27
28
29
30
31
32
•Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

• Outside Stairs are barricaded

• Clean, safe, and age-appropriate toys are provided

• Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

• Documentation of fire and disaster drills are on file – Last drill was conducted on 09/18/24

• No bodies of water are present at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.


Record Review:
• Verification of control of property is not on file; Licensee will provide updated control of property.

• Children’s records were incomplete; a citation will be issued.

• Employee’s records are incomplete; a citation will be issued

• Mandated Reporter Training expired on 9/24

• Pediatric CPR and First Aid Card expires on 9/30/26

• Health & Safety Certificate - completed on 05/19

• During inspection and record review, it was determined that an uncleared adult was providing care. A Type A citation with civil penalties will be issued. And licensee was again reminded that all adults 18 and over, living or working in the home, 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.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelli Waters
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE
FACILITY NUMBER: 376300064
VISIT DATE: 10/23/2024
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
26
27
28
29
30
31
32
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 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: https://www.ada.gov/resources/child-care-centers/

Topics Discussed:
• LPA discussed the safe sleep regulations with 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.
• LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
• Licensee 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.

On-line Licensing forms & regulations for a Child Care Center can be obtained on the Department’s website: www.ccld.ca.gov. Additionally, there is a link to “Receive Important Updates” located on the right side of the page, immediately above Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN).

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send them email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelli Waters
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE
FACILITY NUMBER: 376300064
VISIT DATE: 10/23/2024
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
26
27
28
29
30
31
32
The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200

During the exit interview, the Licensee Mahsan Moosavi-Tabarshiyade, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Citations:
  • 2 Type A (1 with $100 civil penalty)
  • 4 Type B

See LIC809-D for cited deficiencies



A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and this report was reviewed with the Licensee. Appeal rights were discussed and provided during the exit interview.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelli Waters
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 10/23/2024 04:04 PM - It Cannot Be Edited


Created By: Kelli Waters On 10/23/2024 at 02:55 PM
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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE
FACILITY NUMBER: 376300064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, 3 out of 7 children's records were missing LIC 627 form or any emergency medical consent, therefore the licensee did not comply with the section cited above,which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
1
2
3
4
Licensee will provide LPA with LIC 627 for C3, C4, and C7 via email by 11/15/24
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, 1 out of 1 infant under age one was missing the LIC 9227, therefore the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
1
2
3
4
Licensee will provide a copy of a completed LIC 9227 for C7 via email by 11/15/24
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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelli Waters
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


LIC809 (FAS) - (06/04)
Page: 5 of 13
Document Has Been Signed on 10/23/2024 04:04 PM - It Cannot Be Edited


Created By: Kelli Waters On 10/23/2024 at 02:59 PM
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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE
FACILITY NUMBER: 376300064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102371(a)
(a) A fire safety clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal shall be required for a large family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee was operating in a converted garage space that has not been cleared by the Escondido Fire Department and is not covered by the current fire clearance on file, which does not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
1
2
3
4
Licensee will cease using converted garage area for childcare purposes by 10/25/24 and use only the approved "on-Limit" areas until a fire inspection and clearance to use the space has been granted by the Escondidio Fire Department. Licensee will provide proof with photographs that the space is not in use and the areas now being used via email or text to the LPA by 10/28/24
Type A
Section Cited
CCR
102370(d)
(d) 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

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, S2 was providing care and did not have a cleared criminal background record, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
1
2
3
4
Licensee will S1 re-do fingerprints and submit the receipt to LPA via email by 10/25/24. Licensee understands that S2 is not allowed to be on site or provide care until full clearance is granted. Once cleared, Licensee will provide LPA with letter via email.
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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelli Waters
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


LIC809 (FAS) - (06/04)
Page: 12 of 13
Document Has Been Signed on 10/23/2024 04:04 PM - It Cannot Be Edited


Created By: Kelli Waters On 10/23/2024 at 03:11 PM
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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE
FACILITY NUMBER: 376300064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, LPA observed 4 out 7 children's records to be missing proof of immunization, therefore the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2024
Plan of Correction
1
2
3
4
Licensee will provide proof of immunizations for C1, C4, C6 & C7 to LPA via email by 11/15/24
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelli Waters
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


LIC809 (FAS) - (06/04)
Page: 13 of 13