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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605486
Report Date: 12/12/2022
Date Signed: 12/12/2022 03:33:44 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/12/2022 03:33 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LOTFIZADEH FAMILY DAY CAREFACILITY NUMBER:
191605486
ADMINISTRATOR:LOTFIZADEH, OZRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 475-8398
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Orza LotfizadehTIME COMPLETED:
03:00 PM
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On 12/12/2022, Licensing Program Analyst (LPA) Lillian Casillas attempted to conduct an unannounced Annual Required Inspection. LPA met with Licensee, Orza Lotfizadeh, who stated her facility closed due to lack of enrollment since the COVID-19 pandemic and after 36 years working as child care provider. Licensee signed and dated a written statement with the request for closure. LPA collected the statement and the original license from the Licensee.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2022
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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