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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313556
Report Date: 01/28/2022
Date Signed: 01/31/2022 07:38:12 AM

Document Has Been Signed on 01/31/2022 07:38 AM - 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:YAZDANI, SARA NAZFACILITY NUMBER:
304313556
ADMINISTRATOR:YAZDANI, SARA NAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 609-9097
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
01/28/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:LicenseeTIME COMPLETED:
06:30 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 2
Orange County Regional Manager (RM), Bertha Manzanarez and Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an unannounced Case Management inspection for the purpose of serving a Temporary Suspension Order (TSO). TSO action is being taken due to Licensee’s minor child was arrested at the home for possession of a firearm, ammunitions, material of identity theft and drugs. The Licensee's minor child lives at home and according to Licensee, child assist with the day-care.

The license is suspended and the facility is closed for business as of Friday 1/28//2022 at 6:00 p.m. This action is taken under sections 1596.885 and 1596.886 of the California Health and Safety Code, to protect the health and safety of the children in care.

Regional Manager, Bertha Manzanares issued and reviewed the following document to Licensee Yazdani. Licensee was provided with (5) packets with the TSO Parent Letter, Summary of Charges and Accusation to provide the parents of the children currently enrolled in the facility

The following documents were distributed and explained to licensee:
· Temporary Suspension Order
· Statement of Respondent
· Government Code Statutes
· Summary Instructions for the Licensee
· Summary of Charges
· Accusation
· Request for Discovery
· Notice of Defense (2)
Continued on page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2022
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 2
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: YAZDANI, SARA NAZ
FACILITY NUMBER: 304313556
VISIT DATE: 01/28/2022
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 2

A copy of this Temporary Suspension Order will be mailed to your local Resource & Referral agency.

The Notice CLOSED FOR BUSINESS was posted on the front door of the facility. Licensee was advised the notice shall be posted until further notice by the Order of the Director of the Department of Social Services. Removal or concealment of this notice while the Temporary Suspension order is effect is punishable as a misdemeanor with a fine up to $500.00.

Exit interview conducted and report was reviewed with the Licensee, Yazdani Sara Naz.

End of report.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2