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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304313893
Report Date:
07/24/2023
Date Signed:
07/31/2023 11:03:15 AM
Document Has Been Signed on
07/31/2023 11:03 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
ORANGE CO CHILD CARE
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
MIRFATTAHI, SEYEDEH ZAHRA
FACILITY NUMBER:
304313893
ADMINISTRATOR:
MIRFATTAHI, SEYEDEH ZAHRA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(949) 545-4057
CITY:
LAKE FOREST
STATE:
CA
ZIP CODE:
92630
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
07/24/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) A. Bootorabi met with licensee for the purpose of making a correction on a deficiency section number on LIC809 D provided to licensee on 07/07/2023. The deficiency section number doe not change the report or its findings.
Census upon arrival: 3 preschool Age - 1 infant - 2 adults
SUPERVISORS NAME
:
Patricia Magana
LICENSING EVALUATOR NAME
:
Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/24/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/24/2023
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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