Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191210523
Report Date: 01/16/2018
Date Signed: 01/16/2018 12:36:12 PM

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: DATE:
01/16/2018
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Zohreh MozafariTIME COMPLETED:
01:00 PM
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A Supervisory Conference was held by Mary Ruiz, Licensing Program Manager (LPM), and Marina Pilossian, Licensing Program Analyst (LPA) met with licensee Mr. Zohreh Mozafari at the office. This meeting was held because the department had concerns with the operation of her facility. LPM explained the administrative process and further explained that failure to make the necessary corrections, be out of compliance with rules, laws, and regulations, will lead to recommendation for legal administrative action taken against the license or revocation. Licensee has corrected and has been very pro active in correcting all the deficiencies that were issued as stated below. Licensee has also completed the Family Child Care Orientation (FCCH) on this date 01/16/18, and a copy has been obtained for the file. LPM explained that licensee needs to have an assistant when there are more than 8 children. LPM, explained that the department will monitor the license closely, and if necessary the capacity will decrease from 12 to 8 capacity.

The following deficiencies were discussed:

-Personal Rights. Personal Rights: Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment. LPA observed child #1 playing in the living room with a toy (toy walker for the younger children to help them walk). 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.
- 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.
- Operation of a Family Child Care Home- An Emergency Disaster Plan was not observed on the wall. There shall be a written disaster plan per Title 22 and the Health and Safety Code Section 1596.841. The children are at potential risk in case of an emergency if the phone numbers are not immediately accessible.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)337-4341
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (310) 337-4340
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2018
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: 01/16/2018
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- Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
During LPA's visit, licensee was unable to produce a fire and disaster drill log documenting drills conducted once every six months.
- 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.
- 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.
- Employees or volunteers at family day care home; immunization requirements; records; exemptions: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. Per the licensee, she does not have her and spouse immunization's against influenza, pertussis and measles.
- OPERATION OF A FAMILY DAY CARE - LPA observed electrical outlets uncovered in the living room area and the bathroom .
- 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.
- 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. At the time of the visit LPA did not observed License posted.
- At the time of the visit LPA did not observed License posted.
- 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.
- 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.

LPM Ruiz explained licensee not to use the converted garage unless the licensee can obtain permit from the City of Los Angeles. Licensee understands and will comply. Licensee understands that the facility will be on required visit.

Exit interview
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)337-4341
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (310) 337-4340
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2018
LIC809 (FAS) - (06/04)
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