<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313747
Report Date: 07/09/2024
Date Signed: 07/09/2024 02:42:58 PM

Document Has Been Signed on 07/09/2024 02:42 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:NOORI, HOMEIRAFACILITY NUMBER:
304313747
ADMINISTRATOR/
DIRECTOR:		NOORI, HOMEIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 733-1713
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
07/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Page 1 of 4

An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. LPA met with licensees, Homeira Noori who was taking care of 3 children of whom one was under 24 months old. According to the licensee the infant is part time and stays couple of hours in her day care and does not nap. Licensee was operating within the licensed capacity as specified on license for Small Family Childcare Home.

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.

According to licensees, currently there are no other adults and minors living in the house other than the licensee. Licensee stated she is planning to have two more adults to live in the house. LPA provided LIC 279 to licensee to update the form when new adults are added. TB clearance and fingerprinting shall be also submitted for the adults living in the house. Day care hours of operation is Monday through Thursday from 7:30 am-5:30 pm but is open for extended day care and drop in for less than 24 hours a day.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of baby gate, and locks. The childcare area consists of living room only. Licensee stated they have moved the children's area (master bedroom) to living area. No bedrooms will be for children's use. Back yard and side yard are not for children's use. There is a baby gate installed between the kitchen and living room that has made the kitchen inaccessible to children. Fire place in the living room is all covered by plywood. LPA provided LIC 999 to licensee to reflect the changes on the sketch.
Continued on page 2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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 6
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: NOORI, HOMEIRA
FACILITY NUMBER: 304313747
VISIT DATE: 07/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2 of 4

There is crib available for infants and mats are available for older children for napping. Licensee stated the child who is under 24 months old is here for couple of hours and does not nap. Child comes as drop in.
This is a one story home, that consists of 3 bedrooms, 2 and half restrooms, living room, kitchen,
area, garage, back yard and side yard. The garage is accessible from outside the house.

There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards.

Detergents, cleaning compounds, medicines, and other items which could pose a danger to children were not readily available to children they were stored inaccessible to children, none were observed during inspection.

According to licensee, there is no firearm in the facility. There is one cat and two dogs in the house not in the children's area that the dogs would stay until the end of the week. LPA verified there is a working telephone service (cellular service). There is a back yard and side yard but they are off limit. No bodies of water observed.

The licensee does not have a current roster of children in care. Fire Drill was not available. Children’s records for children present during LPA’s inspection were not reviewed. Licensee stated she moved from the children's area from master bedroom to living room and could not find the children's files. The log for every 15 minutes check on napping children under 24 months old were printed out and given to licensee for future enrollment. The licensees' Pediatric CPR/First Aid certifications are current. (Expires 9/17/2024).

Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for the licensee was within compliance.
Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.
Mandated Reporter Training Certificate for the licensee is exempt since the training is not offered in the licensee's native language.
Continued on page 3
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: NOORI, HOMEIRA
FACILITY NUMBER: 304313747
VISIT DATE: 07/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3 of 4


Incidental Medical Services (IMS) policy was discussed. For information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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 and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization, Pediatric CPR/First Aid, and mandated reporter training.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance before working in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee Homeira Noori 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. A copy of LIC 9227 (Individual Infant Sleeping Plan) was given as a reminder to licensee for children under 12 months old. A sample of every 15 minutes check on infant under 24 months old during nap time was given to licensees as a reminder for children under 24 months old.

LPA also informed Licensee, Homeira Tavakoli of the importance of checking for recalled

Continued on page 4

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: NOORI, HOMEIRA
FACILITY NUMBER: 304313747
VISIT DATE: 07/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 4 of 4

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, Homeira Noori was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication. (The licensee is already signed up for this purpose).

In the areas that were evaluated, the following deficiencies were observed of the California Code of Regulations, Title 22, Division 12 on this inspection. Please refer to next page of LIC 809Ds for details of deficiencies.

A notice of site visit was given to licensee, Homeira Noori and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to post will result in Civil Penalties of $100.00.

Exit interview conducted and report was reviewed with the licensee, Homeira Noori.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 07/09/2024 02:42 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 07/09/2024 at 01:10 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NOORI, HOMEIRA
FACILITY NUMBER: 304313747

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2024
Section Cited
CCR
102416.3(2)

1
2
3
4
5
6
7
Alterations to Existing Buildings or Grounds
Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Room additions to the family child care home. This requirement
1
2
3
4
5
6
7
The licensee stated that she would send an updated LIC 999 (sketch) to LPA's email address to show the new changes by the due date of 7/12/2024
8
9
10
11
12
13
14
has not met as evidenced by licensee has moved from children's area from the master bedroom to living room only. Licensee has eliminated back door and side door use as well and not reporting the changes. This is a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
07/12/2024
Section Cited
HSC1596.841

1
2
3
4
5
6
7
Current Roster of Children Provided Care in Facility Roster- Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or
1
2
3
4
5
6
7
The licensee stated she would find children's roster and send copies of children's roster to LPA's email address by the due date of 7/12/2024
8
9
10
11
12
13
14
guardian, and the name and telephone number of the child's physician. This requirement was not met as evidenced by licensee's statement that she has moved from the children's room to living room and could not find the roster. This is a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 07/09/2024 02:42 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 07/09/2024 at 01:28 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NOORI, HOMEIRA
FACILITY NUMBER: 304313747

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2024
Section Cited
CCR
102417(g)(7)

1
2
3
4
5
6
7
An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency,.......... This requirement was not met as evidenced by the licensee's
1
2
3
4
5
6
7
The licensee stated she would send copy of the files and send them to LPA's email address by the due date of 7/12/2024
8
9
10
11
12
13
14
statement that she moved from children's area to living room and could not find the children's files. 3 out of 3 children did not have the files available. This is a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
07/12/2024
Section Cited
CCR101174(d)(2)

1
2
3
4
5
6
7
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year. This requirement is not met as evidenced by licensee's statement that she has moved from children's area to living room
1
2
3
4
5
6
7
The licensee stated she would send a copy of fire drill log to LPA's email address by the due date of 7/12/2024
8
9
10
11
12
13
14
and does not have access to the fire drill log. This is a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
Page: 6 of 6