Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191210523
Report Date: 12/29/2017
Date Signed: 12/29/2017 10:13:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:MOZAFARI FAMILY DAY CAREFACILITY NUMBER:
191210523
ADMINISTRATOR:MOZAFARI, ZOHREHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 344-4740
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY:12CENSUS: 0DATE:
12/29/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:10 AM
MET WITH:Zohreh MozafariTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Marina Pilossian visited the facility for the purpose of a Plan Of Correction (POC) visit.

On the initial visit, 12/15/2017, the licensee was cited for the following deficiencies:
1) Personal Rights: Each child shall be accorded safe, healthful and comfortable. (LPA observed licensee's spouse kick really hard on to the toy while child #1 was still holding on to it. Child #1 was intimidated by the licensee's spouse. Child started to cry).
2) Personal Rights: Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment. (Child #3 was sitting on the yellow small chair and eating lunch. LPA observed child #3 fall face down while on the chair with food in her mouth, and clearly child #3 was not being supervised. LPA observed child #3 crying with food in her mouth and licensee's spouse did not pick up the child, and waited for the licensee (wife) to pick up the child).
3) Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. (LPA observed cleaning chemicals and knives accessible in the kitchen drawers and under the sink and in the bathroom floor.
Licensee did not have safety latches in place making the chemicals, sharp objects accessible to the children).
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)337-4341
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (310) 337-4340
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2017
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: MOZAFARI FAMILY DAY CARE
FACILITY NUMBER: 191210523
VISIT DATE: 12/29/2017
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Licensee was reminded of the following:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Exit interview and copy of report was provided.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)337-4341
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (310) 337-4340
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2017
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: MOZAFARI FAMILY DAY CARE
FACILITY NUMBER: 191210523
VISIT DATE: 12/29/2017
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4) Immunization records for staff, volunteers (Per the licensee, she does not have her and spouse immunization's against influenza, pertussis and measles).
5) OPERATION OF A FAMILY DAY CARE - (LPA observed electrical outlets uncovered in the living room area and the bathroom).
6) Operation of a Family Child Care Home: (Licensee did not have a Facility Roster that included the ages of the children or their enrollment/last date in care. Facility roster was not updated).
7) Operation of a Family Child Care Home- (An Emergency Disaster Plan was not observed on the wall).
8) Operation of a Family Child Care Home. ( During LPA's visit, licensee was unable to produce a fire and disaster drill log documenting drills conducted once every six months).
9) Immunization. Licensee shall document and maintain each child’s immunization's as long as the child is enrolled. (LPA reviewed children's files and observed missing Immunization record for child #3).
10) Parents Rights. The Licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in an accessible area in the family child care home at all times children are in care. (LPA did not observe the Parent's Rights poster to be posted in a prominent area of the home).
11) At the time of the visit LPA did not observed License posted.
12) OPERATION OF A FAMILY CHILD CARE HOME: The home shall provide safe toys, play equipment and materials. (LPA observed broken toys in the back yard).
13) Operation of a Family Child Care Home. A baby exersaucers are not permitted on the premises of a family child care home. (At the time of the visit LPA observed an exersaucers in the back yard).
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)337-4341
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (310) 337-4340
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2017
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: MOZAFARI FAMILY DAY CARE
FACILITY NUMBER: 191210523
VISIT DATE: 12/29/2017
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Upon LPA's arrival LPA observed no children with licensee. Per licensee she has taken the day off. Licensee stated to LPA that her husband is in the home in the bedroom. LPA checked facility personnel report summary for all adults finger printed and associated to the facility. LPA toured all areas of the home inside and outside with the licensee.

LPA observed the above deficiencies corrected. LPA reviewed children's files for completeness. LPA observed all children's files complete including the files that were missing documents. Licensee has five day care children enrolled at the facility at this time. LPA observed Acknowledgement of Receipt of Licensing Reports LIC 9224 in the children's files. Licensee has met the Plan of Corrections for the above deficiencies. LPA observed licensing report (LIC809) and the notice of site visit posted on the wall by the entrance. LPA observed all the required licensing documents posted on the wall. LPA observed a white door plastic knob on the converted garage door. Per licensee she is not using the converted garage into a bedroom for the day care children. LPA explained to the licensee that the garage is converted without permits and cannot be used for the day care children. If and when licensee can provide the Department with a copy of the Certificate of Occupancy permits obtained from the City of Los Angeles that the garage is converted legally with permits, then the Department will inspect the converted garage for use of the day care children. Licensee understands and will not use the converted garage. LPA observed the yard and found it to be clean and orderly. LPA observed toys that were in good repair and age appropriate. Children can play in the yard with supervision and visual observation.

Licensee requested to utilize the master bedroom for the day care children. LPA inspected the master bedroom. LPA informed licensee that she can use both the bedrooms in the hallway for the children. LPA informed the licensee that both bedroom doors must be kept open for visual observation and supervision at all times. LPA explained to the licensee that the hallway door must be kept open when children are in the bedrooms. Licensee understands and agrees.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)337-4341
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (310) 337-4340
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2017
LIC809 (FAS) - (06/04)
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