197418638-8-26-2022-58-CC-DMIA-CHNW26-20220826165349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418638
Report Date: 08/26/2022
Date Signed: 08/26/2022 04:53:59 PM

Document Has Been Signed on 08/26/2022 04:53 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MIRZADEH FAMILY CHILD CARE		FACILITY NUMBER:	197418638
ADMINISTRATOR:	MIRZADEH, MANIJEH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 606-8634
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 4	DATE:	08/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Manjeh Mirzadeh Licensee and Licensee's assistant		TIME COMPLETED:	05:00 PM

NARRATIVE

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On 8/26/2022 at 1:55PM Licensing Program Analyst (LPA), Denise Miranda conducted an unannounced Annual Required Inspection and was met by Licensee, Manijeh Mirzadeh. Also present was one Licensee’s Assistant, and 4 children (who 3 were infants). Per Licensee, her operation hours is from 7am to 6pm – Monday – Friday.

Per Sketch, Licensee, converted the detached recreation room along with bathroom. Licensee provided copy of certificate of occupancy and showing that detached converted an existing 1 story has a new address 6451 N. Bothwell Road, 91335.

LPA observed a fence, separating the detached converted reacreation room to the backyard. Licensee, will submit an update lic999A. Licensee was advised that any changes she shall to report to El Segundo Regional office.
The following areas are designated as follows and Licensee confirmed that the: Living room, play room, bedroom #1 and Bathroom#2 , backyard were accessible to the children in care.
The off-limit: the recreation room, carpool, kitchen, laundry room, bedroom#2#3#4, and bathroom #1.
There is no swimming pool was observed on the premises. There are no firearms or ammunition on the premises. Poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items, Licensee made inaccessible during this inspection. Licensee is aware that all products such as Clorox, detergents or any type of poison shall be inaccessible to the children in care.

LPA observed a fireplace located at the living room, has been barricade with screen. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Safe toys and play equipment

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIRZADEH FAMILY CHILD CARE	FACILITY NUMBER: 197418638
	VISIT DATE: 08/26/2022

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are observed. Furniture was observed with no loose or sharp parts, clean and in good repair.
The home has working telephone service and LPA confirmed the phone number is (818) 606-8634.

LPA discussed Safe Sleep Regulations with licensee.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats were not observed at facility. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed all children’s files and Licensee was unable to produce the file of child#4. Licensee was unable to proof of Mandated Reporter Training for her and her assistant. Licensee’s pediatric CPR/First Aid completed on 12/11/2016 and is due for renewal on 12/11/2018. There 1 currently employee at the facility, Licensee was unable to produce the Licensee’s assistant file.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIRZADEH FAMILY CHILD CARE	FACILITY NUMBER: 197418638
	VISIT DATE: 08/26/2022

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

An unannounced continuation Inspection required -1- year will be conduct later.

LPA will conduct a staff interview on the continuation inspection.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee. Report, Appeal Rights and Notice of Site Visit were given to Licensee

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/26/2022 04:53 PM - It Cannot Be Edited

Created By: Denise Miranda On 08/26/2022 at 03:55 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIRZADEH FAMILY CHILD CARE	FACILITY NUMBER: 197418638
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(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 observation, and record review, the licensee did not comply with the section cited above. Licensee was unable to produce immuzization card to child #4 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/02/2022
	Plan of Correction
1 2 3 4	Licensee agreed to provide via email no later than 09/2/202 via email to LPA Miranda, proof of immunization for child#4.

Type B

Section Cited

CCR

102425(j)(2)(D)

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: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in Child#1,#3 and #4 (infants in care), Licensee was unable to produce, safe sleep log - 15 minutes. which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2022
	Plan of Correction
1 2 3 4	LPA provided a sample of safe sleep log, and Licensee will implement starting next business for every single infant in care. Licensee will send a copy of safe sleep log for the day 08/29 and 08/30 no later than 08/31/2022.

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:

Lisa Rios

LICENSING EVALUATOR NAME:

Denise Miranda

LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC809 (FAS) - (06/04)

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