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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313567
Report Date: 04/28/2023
Date Signed: 04/28/2023 01:52:15 PM

Document Has Been Signed on 04/28/2023 01:52 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:VAZIRIMIRAEI, GHAZALEHFACILITY NUMBER:
304313567
ADMINISTRATOR:VAZIRIMIRAEI, GHAZALEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 558-6607
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Ghazleh VazirimiraeiTIME COMPLETED:
02:15 PM
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Mrs. Bootorabi. Upon arrival, an Entrance Checklist (LIC 126) was provided to the licensee Ghazleh Vazirimiraei.

Census upon entry:
Infants: 1
Children Over Two: 6
Adults Working Directly with Children: 2
Other Adults: 1
The licensee was operating within the licensed capacity as specified on the license. The Facility Day care hours are 7:30 am - 5:30 pm, Monday through Friday.

Posted Requirements were reviewed at 9:06 am. Upon arrival, the LPA verified that the following documents were posted in a prominent, publicly accessible area; License, PUB 394 Notification of Parents’ Rights, and LIC 9148 Earthquake Preparedness. The licensee met the posting requirements during today says inspection.

Facility Tour began 9:10 am. The LPA and licensee toured the facility inside and outside. The facility sketch was verified. Areas stated to be off-limits by the facility sketch were made off limits by means of baby safe gates.

Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VAZIRIMIRAEI, GHAZALEH
FACILITY NUMBER: 304313567
VISIT DATE: 04/28/2023
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Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. The children's bathrooms are clean and sanitary. Children nap play yards and cots bedding is taken home weekly to be washed by parents and some is washed by the licensee. . All soiled blankets and clothing are disposed or washed immediately depending on the substance on it stated by the Licensee was given a consultation on storing children's sheets individually for sanitary reasons.

The licensee stated the children's primary care and play areas consist of the living room, bathroom and backyard. The home has age-appropriate toys for the ages served indoors.

During the inspection of the indoor activity space, items that could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. The LPA observed Poisons/Hazardous Items (detergents, cleaning compounds, and medications) out of reach of children in care.

A consultation was provided regards the equipment and material used outside. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary, and in good repair.The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was maintained and free of dangerous hazards to children The outdoor activity space was inspected for compliance. The activity flooring for outdoors consisted of artificial grass and cement.

Identify Location & Functioning: The licensee tested the smoke detector during today’s inspection and was functioning. The fire extinguisher was visible, accessible, and marked full during todays inspection. A carbon monoxide detector was not identified but licensee met the requirement before the end of the inspection.

Records Reviewed began at 9:52 am. The LPA requested to review the LIC 610A Emergency Disaster Plan, Verification of Disaster and Fire Drills, and LIC 9040 Facility Roster. The last drill was conducted on March 14, 2023. The licensee met the requirements during the inspection and LPA reminded the licensee of the importance of keeping documents up to date to comply consistently.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VAZIRIMIRAEI, GHAZALEH
FACILITY NUMBER: 304313567
VISIT DATE: 04/28/2023
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Personnel Recordsreview began at 9:58 am. The LPA requested completed personnel records for assistant #1 and licensee for review during today’s inspection. The following documents were reviewed in the files provided by the licensee; CPR First Aid Certification, LIC 9052, Immunization records, TB clearance and LIC 9108, and a Mandated Reporter Training Certificate. A consultation was provided about the importance of keeping records for adults working with the children. Assistant #1 file was completed and met requirements

CPR & FIRST AID:Family daycare homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility and shall be present with the children when children are offsite from the facility for facility activities. Assistant (completed 3/12/2023) & Licensee met the requirements.

Mandated Reporter Training: Health and Safety Code (HSC) section 1596.8662 requires all licensed child care providers, administrators and employees of licensed child care facilities, and applicants for family child care home licenses to complete child abuse-mandated reporter training and to renew the training every two years.For additional information and resources on Child Abuse Mandated Reporting, please see the CDSS Resources for Providers. For all other questions, please contact your Local Regional Office. https://mandatedreporterca.com/ Assistant & Licensee met the requirements.

Children’s Records Reviewed at 10:06 am.The LPA requested completed children’s records of children enrolled. Children's records were reviewed, and there was a separate, incomplete record for each child. The LPA reviewed files to verify the following documents LIC 282 Affidavit Regarding Liability Insurance, Immunization Records, LIC 700 Identification and Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. The licensee was not in compliance and a consultation was provided to support the licensee to meet compliance.

Individual Sleep Plans and Sleep Logs were reviewed at 10:38 am . LPA observed (2 of 2infants) from 0-24 months. 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 maintained at the facility in the infant’s file. LPA observed and reviewed LIC 9227 Individual Infant Sleeping Plan in children’s files.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VAZIRIMIRAEI, GHAZALEH
FACILITY NUMBER: 304313567
VISIT DATE: 04/28/2023
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Safe SleepConsultation began 12:15 pm

The licensee admits to checking infants every 15 minutes and described what to look for checking for infants.License is not in compliance with Safe Sleep Regulation. The LPA provided consultation to support the license meet the requirements. At this time the LPA gave the licensee a copy of sample log. The licensee was consulted on putting initials on the daily checks ( of whom ever is checking the infant.) The licensee is serving one child over 12 months at this time.

During today’s inspection, the licensee and LPA discussed the following:

- Stay up to date with LIC 9227 and discuss with parents any new changes


- Ensure 15 min checks are conducted & logged (The initial of the person checking should be included)
- 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.
- Always place infants on their backs to sleep
- Use only a tight-fitting sheet on the crib or play yard mattress
- Do not hang any items from the crib or above the crib
- Keep all items, including blankets, out of the crib or play yard
- Pacifiers may be used if they do not have items attached to them
- Infants should not be swaddled or have any items covering them while sleeping
- The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

The following are additional resources.
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
The American Academy of Pediatric https://www.aap.org/en/patient-care/safe-sleep/
Safe Sleep Regulations https://cdss.ca.gov/Portals/9/Additional-Resources/Legislation-and-Regulations/Public%20Hearing%20Docs/f031803RegulationsTextOALfinal.pdf
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VAZIRIMIRAEI, GHAZALEH
FACILITY NUMBER: 304313567
VISIT DATE: 04/28/2023
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Incidental Medical Services (IMS) policy was discussed and the licensee stated she does not provide IMS currently in her FCCH. 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)

Commonly Asked Questions American Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Know the Law About The Americans with Disabilities Act and Individuals with Disabilities Education Act https://rrnetwork.org/assets/general-files/Child-Care-Law-Center-ADA_IDEA_Housing-April-2019.pdf

Background Checks :A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, there are 2 adults including the licensee and 1 minor child living in the facility. The licensee was reminded that any individuals 18 years or older must have a background check clearance. The licensee was also reminded that any children turning 18 years must obtain a background check to maintain compliance.


LPA provided Guardian Information and website info:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Video: https://ccld.childcarevideos.org/family-child-care-providers/background-check-requirements-for-caregivers/
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
Page: 5 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VAZIRIMIRAEI, GHAZALEH
FACILITY NUMBER: 304313567
VISIT DATE: 04/28/2023
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Reminders: CCLD website www.ccld.ca.gov was provided to licensees to access regulations, updates, and licensing forms.

The licensee was informed of the important updates available at www.ccld.ca.gov and may request to be added to an email list to receive Community Care Licensing Important Notifications from the above website and selecting Receive Important Updates: https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Other useful resources include https://ccld.childcarevideos.org/family-child-care-providers/

Technical Assistance and Advocacy Bureau

The Community Care Licensing Division, Technical Assistance and Advocacy Bureau will host a webinar via phone or ZOOM to inform providers about the no-cost services offered by the Technical Support Program (TSP).

Webinar Date and Time Tuesday, June 6, 2023, 6:00 p.m.

Register in advance for this webinar: Zoom Registration Link After registering, you will receive a confirmation email containing information about joining the webinar. Tip: Save the link to your Outlook calendar for easy access to the webinar.

https://us02web.zoom.us/webinar/register/WN_fJWLW7U8Q-StwMIlUxMjaA

The licensee understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VAZIRIMIRAEI, GHAZALEH
FACILITY NUMBER: 304313567
VISIT DATE: 04/28/2023
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The LPA provided a consultation about licensing fees and provided the resources for licensee to complete this task.


An exit interview was conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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

End of Report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
Page: 11 of 11