304313780-6-23-2023-06-CC-STOE-CT3S27-20230623132905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313780
Report Date: 06/23/2023
Date Signed: 06/23/2023 01:29:17 PM

Document Has Been Signed on 06/23/2023 01:29 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	JAVADIAGHDAM, MAHNAZ		FACILITY NUMBER:	304313780
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 5	CENSUS: 5	DATE:	06/23/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Mahnaz Javadiaghdam, Licensee		TIME COMPLETED:	01:40 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	Licensing Program Analysts (LPAs) Stacy Torrence and Karen Navar conducted a case management inspection, in response to licensee’s request for a capacity increase. LPAs met with licensee Mahnaz Javadiaghdam, who guided analyst on a tour of the facility. LPAs observed five children in the designated daycare area. The facility was within licensed capacity and the required ratio. Licensee stated there is currently two adults and one minor child living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility is a two-story home with three bedrooms, two and half bathrooms, living room, family room, kitchen, dining room, laundry room, garage, front yard (not fenced) and fenced backyard. The licensee has designated the living room, family room, half bathroom, kitchen and fenced backyard as part of her day-care. The licensee has designated the entire 2^nd floor, laundry room, and the front yard as the off-limit areas. Licensee has placed a child proof safety gate, at the bottom, of the stairs, leading to the 2^nd floor, ensuring the areas are inaccessible to the children in care. Licensee placed a child proof safety latch on the doorknob of the laundry door, ensuring this area is inaccessible to the children in care. The licensee acknowledged the children may never enter the off-limit areas during operation hours. Control of property was verified by LPAs during today’s inspection. The licensee has a cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. The licensee was informed and understands the home is to be free from smoking during hours operation hours.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: JAVADIAGHDAM, MAHNAZ	FACILITY NUMBER: 304313780
	VISIT DATE: 06/23/2023

NARRATIVE

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The facility has a fireplace, located in the living room; barricaded by a glass door and screen, ensuring they are inaccessible to children in care. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Poisons/Hazardous items are not stored on site, and none were observed. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. Licensee stated there are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.

Licensee uses the backyard for children's outdoor activities. The back yard is appropriately fenced. LPAs observed play equipment to be safe and free of hazards. There are no bodies of water on the premises.

Per licensee, she provides food for the children. LPAs reminded applicant, that if food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.

Per licensee, all children will nap in the family room. Licensee stated parents will provide linen and blanket for the children.

Licensee’s Mandated Reporter Training were current. EMSA approved Pediatric CPR and Pediatric First Aid was current for licensee, which expires on 01/2024.

The licensee has a current roster of children in care. During this inspection, LPAs reviewed 4 children’s records and they were in compliance. The licensee does not have a current disaster drill log.

LPAs advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: JAVADIAGHDAM, MAHNAZ	FACILITY NUMBER: 304313780
	VISIT DATE: 06/23/2023

NARRATIVE

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LPAs discussed the safe sleep regulations with facility representative 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. LPAs also informed 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 reminded that all adults 18 and over, 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 Child Care Family 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.

Fire clearance granted on 06/08/2023.

The facility was not in compliance and a violation of California Code of Regulations, Title 22, Division 12 was observed, discussed and a Technical Assistant was given today for 102417(g)(9)(A) Operation of Family Child Care Home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

An Inspection and exit interview were completed with licensee. The report was reviewed and discussed. Appeal Rights was discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. Licensee was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC809 (FAS) - (06/04)

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