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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314100
Report Date: 03/02/2023
Date Signed: 03/02/2023 04:14:56 PM

Document Has Been Signed on 03/02/2023 04:14 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:PIRASTEHFAR, AREZOOFACILITY NUMBER:
304314100
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:ApplicantTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced in-person Pre-Licensing inspection for the purpose of operating a new Small Family Child Care home. LPA met with Applicant, Arezoo Pirastehfar who provided a tour of the home.

A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared.
Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office.

Applicant is requesting for a Small family childcare home license. Operation hours will be Monday to Friday 7:30 AM to 6:00 PM and care and supervision will be provided to children ages one months old to 12 years old.
All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story single family home with 4 bedrooms, 3 bathrooms, living room, family room, dinning area, kitchen, garage, and back yard.

Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation and heating. Telephone service (cell phone is the primary contact phone) .

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children stored in the locked garage and top cabinets. The Licensee states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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: PIRASTEHFAR, AREZOO
FACILITY NUMBER: 304314100
VISIT DATE: 03/02/2023
NARRATIVE
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Based on the Facility Sketch submitted, areas off limits to children are: .

Parents and children will enter the home, through the main door to the day care area. The applicant has designated living room, dining room, family room, and one bedroom for day care children. There is one bathroom designated for children usage. The children's area has been separated by a baby gate to make the kitchen area, living room, and dinning room inaccessible to children. The applicant is willing to use the living room/dinning room area when she has more children.

The designated day care area is for eating, playing, reading, and day care activities. This area was observed to have age appropriate activities and educational items for enrolled children. One bedroom is designated for napping children. There are two cribs in the family room. There were no sheets for these two cribs available. Mats will be provided by the applicant for older children's napping. The applicant was advised that she shall provide ongoing supervision during nap time. Every 15 minutes check on children under 2 years old and documenting on the log was discussed with applicant, Arezoo Pirastehfar. A sample copy of the log for every 15 minutes check was given to the applicant. The items and equipment pictures that are not allowed in day care facilities was given to the applicant as well.

There is a garage attached to this house. Garage is locked with 2 sets of locks. The applicant was informed that garage is not for children's usage.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked. There is a gate installed on the bottom of the stairs to make the bedrooms on the 2nd floor inaccessible to children.

Applicant will use the cell phone for day care and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation.



Applicant was informed and understands the home is to be free from smoking during hours of operation.
Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

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

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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: PIRASTEHFAR, AREZOO
FACILITY NUMBER: 304314100
VISIT DATE: 03/02/2023
NARRATIVE
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The applicant has provided the proof of control of property to LPA..

The children's bathroom is located next to the children's' area in the hallway for children's use. There are cabinets under the sink. The cabinets and drawers under the sink were locked. The children's bathroom was observed to be safe and free of hazardous items.

Applicant does provides AM/PM snacks and lunch to children. If food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Upon entrance through the designated main door of the home, applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines,

OUTDOOR PLAY AREA: Applicant's home has a back yard with one side gate which was locked. The yard is all fenced.

There are no body of water, firearms, weapons, in the home. However, there is dog living in the house from the Cavapoo Breed.

The fire extinguisher met the licensing requirements. The applicant has the right size of 2A10 BC fire extinguisher. Smoke Detector was tested and was in working condition. However, there is no Carbon Monoxide detector in the house.



Due to pandemic parents are encouraged to follow CDC guidelines.
Applicant has completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 9/2024.


The following was discussed with the applicant: In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First

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

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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: PIRASTEHFAR, AREZOO
FACILITY NUMBER: 304314100
VISIT DATE: 03/02/2023
NARRATIVE
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Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility license.

Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated. The fire extinguisher type 2A-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No Johnny jumpers, No Baby walkers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.

Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

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



LPA discussed the following items with the Applicant, Arezo Pirastehfar during the Exit interview:

Criminal Record statement: Applicant, Arezoo Pirastehfar 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
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
Page: 4 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: PIRASTEHFAR, AREZOO
FACILITY NUMBER: 304314100
VISIT DATE: 03/02/2023
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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.


Safe Sleep : LPA discussed the safe sleep regulations with applicant, Arezoo Pirastehfar & 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 of the applicant, Arezoo Pirastehfar 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.

Incidental Medical Services (IMS) policy was discussed. For IMS 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: http://www.ada.gov/childqanda.htm.

Review of records to be maintained : LPA reviewed with Applicant, Arezoo Pirastehfar the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. (LPA gave the LIC 311D with all the required forms and Fire logs to be maintained in the home). A packet of enrollment for children was discussed and posting forms were printed out.

Subscribe to CCLD important information

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 platform. To receive important license- related information to

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

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
Page: 5 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: PIRASTEHFAR, AREZOO
FACILITY NUMBER: 304314100
VISIT DATE: 03/02/2023
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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

OTHER INFORMATION AND FORMS PROVIDED:



Capacity Handout for a Small Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment. The facility at the time of Pre-licensing inspection is not in compliance for a (Small Family Child Care Home) with Title 22 Regulations

Exit interview was conducted and report was reviewed with the applicant, Arezoo Pirastehfar.


Appeal rights were presented.

A license for a Small family childcare home will be issued after receiving the following, final review and management approval.

1- Providing sheets for the cribs (2 cribs)
2- Providing mats for older children during nap time.
3- Carbon Monoxide Detector.
4- A picture of posting requirements.

End of report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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