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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400845
Report Date: 01/08/2025
Date Signed: 01/08/2025 04:26:50 PM

Document Has Been Signed on 01/08/2025 04:26 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KHOSHBAKHSH, JACKLIN F.D.C.FACILITY NUMBER:
197400845
ADMINISTRATOR/
DIRECTOR:		KHOSHBAKHSH, JACKLINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 840-0738
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 17DATE:
01/08/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Licensee Jacklin KhoshbakhshTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On January 8, 2025, at 11:35 am Licensing Program Analysts (LPAs) Priscilla Ochoa conducted an unannounced annual inspection at the above facility. LPA was greeted by licensee Jacklin Khoshbakhsh, who guided LPA on a tour of the facility. Licensee’s, assistant was also present for the inspection. Per licensee there is 14 child enrolled, and LPA observed 17 children in care. Hours of operation are Monday through Thursday from 8:00 am to 4:00 pm and Fridays 8 am – 1 pm .

Family members residing in the home are 3 adults who have criminal record clearance. This is a two-story home that consists of 5 bedrooms, 4 bathrooms, 2 playrooms, living room, dining room, laundry room, kitchen, swimming pool and backyard which is fenced.



Off limit areas is the entire second floor which includes 4 bedrooms, 2 bathrooms. The front yard, kitchen, bathroom towards the back of the house and detached garage are also off limit areas.

Areas accessible to children is the bathroom near the front door, living room, dining room, 2 playrooms, 1 bedroom towards the side of the playrooms and backyard. Per licensee, the living room, dining room and back bedroom are only used for napping.

11:40 am, licensee guided LPA on a tour of the areas that are accessible to the children in care. Upon entrance of the front door, LPA observed a baby gate on the staircase, making the staircase and the second floor inaccessible. The bathroom next to the front door was inspected and observed to be clean. LPA did not observe any materials that can pose a danger to children. LPA then observed the living room area and 6 preschool children and 2 infants getting ready for nap time. Napping equipment was observed in the form of cots and playpens. Bedding was observed for cleanliness and appropriate storage. Per licensee, bedding is washed at the facility weekly. A fireplace was observed in the living room, which was barricaded, making it inaccessible to children in care.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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 11
Document Has Been Signed on 01/08/2025 04:26 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/08/2025 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as licensee was over raito. Licensee had 9 infants and 8 preschool children, while her capcity its 4 infants and 8 preschool children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/08/2025
Plan of Correction
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LPA observed licensee call 5 infants parents to pick up their child. Licensee will also write a declaration stating that the facility will alway be within capacity ratios.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 2 of 11
Document Has Been Signed on 01/08/2025 04:26 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/08/2025 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above as licensee does does not have a 2A-10BC fire extinguisher that was serviced or purchased with in the last year, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2025
Plan of Correction
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Licensee will purchase a new 2A-10BC fire extinguisher and send LPA P. Ochoa proof of purchase by POC date of 1/13/2025
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as 2 out of 2 staff did not have current mandated repoter training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee and assistant will take mandated reporter training and licensee will send LPA P. Ochoa proof of certificates by POC date 1/15/2025
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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 3 of 11
Document Has Been Signed on 01/08/2025 04:26 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/08/2025 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above as licensee does not have current First Aid/ CPR training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee will take a EMSA approved First Aid/ CPR training and provide LPA P. Ochoa proof of completed certficate by POC date of 1/17/2025
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above as assistant did not have a file for LPA to review. Assistant will need to obtain MMR, TDAP, TB immunizations, LIC 9052 and LIC 9108 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee will gather the infomation above from assistant and send proof to LPA P. Ochoa by POC date 1/17/2025
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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 4 of 11
Document Has Been Signed on 01/08/2025 04:26 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/08/2025 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 12 children were missing individual sleep plan, 2 out of 12 children were missing immunization records, 6 out of 12 children did not have a file for LPA to review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee will create files and make sure all children in care have all form that are required by the department in their file. Licensee will send completed files to LPA P. Ochoa by POC date of 1/15/2025
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review)], the licensee did not comply with the section cited above as in 4 out of 12 children were missing 15 minute safe sleep log checks, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Licensee will start documenting safe sleep logs for infants in care and send LPA a copy of logs by POC date of 1/10/2025
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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 5 of 11
Document Has Been Signed on 01/08/2025 04:26 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/08/2025 at 03:34 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)
A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use. (II) A licensee shall maintain and make available for inspection, upon request by the department, documentation that establishes the alarm is compliant with ASTM International Standard F2208. (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use:(A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.(B) A rescue pole with a body hook and a minimum fixed length of 12 feet. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above a licensee does not have a pool alarm, life ring and rescue pool which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2025
Plan of Correction
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Licensee will go over new Pool regulations and purchase pool alarm, life ring and rescue pool. Licensee will send LPA P. Ochoa proof or purchased items by POC date 1/15/2025

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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 7 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845
VISIT DATE: 01/08/2025
NARRATIVE
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Licensee guided LPA to the back room where the 2 playrooms are located. LPA observed 6 infants and 2 preschool aged children in care with one assistant present. LPA then heard another infant cry in the bedroom towards the side of the playroom room. LPA observed a total of 8 preschool children and 9 infants in care. LPA explained to the licensee that the facility is currently operating over ratio. At 12 pm, licensee started calling the parents of 5 infants to be picked up at the facility. At 12:19 pm, the facility was operating back in compliance with title 22 regulations for capacity and ratio. In the playrooms, LPA observed several age-appropriate toys for children in care, children’s cubbies, and parent/licensing board. LPA then inspected the backyard and observed more age-appropriate toys for children in care. LPA also observed a swimming pool that is enclosed with a five-foot rod iron fence with a gate that opens away from the swimming pool and self closes and self-latches. LPA discussed with licensee new pool regulations and advice licensee to go over updated regulations. All areas were observed to be clean, orderly, comfortable, and well ventilated.

There are first aid supplies available. Per licensee, the facility does not provide any meals to children in care. Children bring their own snacks and lunch. LPA reminded licensee, food that is brought from home must be in a stored properly and in closed container. The bedroom next to the playroom is being used as an isolation area at this time, while child’s parents are called for pick up. A cot is available if needed.

Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children.

LPA observed a smoke/carbon monoxide detector in the playroom area. LPA did not test detectors, as children were napping. A 2A-10BC fire extinguisher was observed. Licensee did not have a receipt for date of purchase of the fire extinguisher. Per licensee, the fire extinguisher was purchased last year. LPA noticed that the bottom of the fire extinguisher the year 2016 was printed. LPA explained to the licensee that fire extinguishers must be serviced or purchased yearly. There is a working telephone on site.

Per the licensee, there are no firearms or pets on the premises.

LPA conducted a children file review and deemed not complete. 1 out of 12 children were missing individual sleep plan, 2 out of 12 children were missing immunization records, 4 out of 12 children were missing 15 minute safe sleep log checks, 6 out of 12 children did not have a file for LPA to review. Licensee will create files and make sure all children in care have all form that are required by the department in their file. LPA also suggested that licensee go over safe sleep PIN to stay in compliance.

Page 2 of 5

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 8 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845
VISIT DATE: 01/08/2025
NARRATIVE
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LPA conducted staff file review and deemed not complete. Licensee could not provide a current pediatrics first aid and CPR certificate and current mandated reporter certificate. LPA also observed that licensee’s assistant did not have a file with required licensing forms. Licensee will create an assistant file and make sure all form that are required by the department in their file.

All childcare employees must complete mandated reporter training within 30 days of hire and renew training every two years at www.mandatedreporterca.com

Per the licensee, fire and disaster drills are conducted every 6 months. Per licensee last disaster drill was conducted in October 2024. LPA reminded licensee that disaster drills must be documented with the time and date the drill was conducted.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) and Emergency Disaster Plan (LIC610a).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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)/ (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

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The on Duty Worker is available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

Page 3 of 5

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 9 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845
VISIT DATE: 01/08/2025
NARRATIVE
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The following was discussed with the licensee:
Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee was reminded that supervision is always required to children in care.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.


-- Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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 childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Page 4 of 5

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 10 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845
VISIT DATE: 01/08/2025
NARRATIVE
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The licensee, Jacklin Khoshbakhsh confirmed that there are no Registered Sex Offenders living in the facility.

LPA provided consultation during inspection.

LPA P. Ochoa informed licensee Jacklin Khoshbakhsh that this report dated January 8, 2025 document(s) (number of Type A citation) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.


Also, LPA P. Ochoa informed the licensee Jacklin Khoshbakhsh to provide a copy of this licensing report dated January 8, 2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Type B deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of the report was provided, along with appeal rights to licensee, Jacklin Khoshbakhsh.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
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