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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313893
Report Date: 07/22/2024
Date Signed: 07/22/2024 12:20:34 PM

Document Has Been Signed on 07/22/2024 12:20 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MIRFATTAHI, ZAHRAFACILITY NUMBER:
304313893
ADMINISTRATOR/
DIRECTOR:		MIRFATTAHI, ZAHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 545-4057
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
07/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Zahra MirfattahiTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 07/22/24 at 8:50AM, Licensing Program Analyst (LPA), Christine Jung arrived at 24092 Gemwood Drive. LPA observed Adult 1 (A1) carrying an infant (Child 1) and walking away from the home. LPA observed a red car parked in the driveway with three (3) adults and two (2) children (Child 2 and Child 3). Child 2 (C2) and Child 3 (C3) were crying in the backseat. There was another adult (Adult 5) walking back and forth from inside the house to the driveway.

LPA approached Adult 2 (A2) who was in the backseat of the red car and inquired about the C2 and C3 in the backseat. A2 stated that the children belonged to their friend. The older of the two children, C2, provided their names, date of birth, parent name, and phone number. While interviewing the children, A2 stated that the children were going to the park. LPA observed that the car was not equipped with car seats for the two children. When LPA mentioned the lack of car seats to A2, A2 stated that the children’s parent was returning with car seats. LPA asked A2 to make sure the children do not leave the premise until their parent arrived. When questioned about the infant (C1) that was being carried away from the home, A2 did not provide a clear answer as to the C1’s identity. C2 stated the infant was somebody else’s sibling.
LPA approached the front door of the home as Adult 5 (A5) came out toward the driveway. When interviewed, A5 stated the children were being supervised by A2, and they were all going to the park. A5 stated the children were all part of A2’s daycare, and A2 is the previous licensee of the home. While interviewing, LPA heard a thumping noise come from a Lexus SUV which was also parked on the driveway. LPA asked for the car door to be opened and observed two additional children (C4 and C5) in the backseat without adult supervision. The car engine was not turned on, windows and doors were all closed, both children were visibly sweating. LPA interviewed C4 and C5. C5 did not verbally respond, but C4 provided their names. When asked about the “baby” C1, C4 stated they were siblings.
LPA asked A2 and A5 multiple times regarding the identity of C1. Each time, A2 stated that C1 was not a sibling and C1 was with their parent.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 07/22/2024
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Around 9:00AM, LPA requested for all children to return back into the home for safety. LPA also requested for C1 to be returned with the adult who was carrying them. LPA spoke with parent of C2 and C3, and parent stated they were returning with car seats. Parent stated they were told the daycare was closed for the day but was not aware that A2 had surrendered their license to the Regional Office and was permanently closed.
LPA also spoke with parent of C1, C4, and C5 (C1, C4, and C5 are siblings). Parent was on their way back to the facility and arrived within five minutes of the phone call. When parent arrived, parent stated that they knew the facility was closed, and they knew the children were going to the park. In the backseat of the parent’s car was C1 and A1. Parent stated they were accompanying A2 to the park. Parent also confirmed that C1 is their child and the youngest of the three siblings. Parent provided LPA their own name and contact information, children’s names, and children’s date of birth. Parent picked up C4 and C5 and left the home.
Around 9:45AM, C2 and C3 were picked up by their parent.

A2 stated they notified all families enrolled on Friday, 07/19/24, that daycare was closed as of that date. S2 stated they wanted to take the children to the park today 07/22/24 for a celebration.

LPA explained to A2 that as one who is unlicensed, they cannot provide care to more than one family.
LPA advised A2 regarding Health and Safety Code Section 1596.80 violation, a license is required by Law if caring for children from more than one family that are not related. Notice of Operation in Violation of Law, License Exemptions Regulations, Family Child Care Provider Requirements, LIC279 (application), Inspection Authority of the Department, Operation without a License were provided to (A2) Zahra Mirfattahi.

LPA explained that the facility must cease operation or submit a completed application to Community Care Licensing Office within 15 business days from today’s date, application due by 08/06/2024. Mirfattahi acknowledged that they understand the instructions to apply for a Family Child Home Care license. Continued day care without a license is against the law and failure to discontinue care could result in a civil penalty of $200 a day and could impact the ability to get future license. Providing unlicensed care is a violation of the CA Health & Safety Code, Sec. 1596.80.

LPA discussed the application process and orientation classes and provided Community Care Licensing website address: www.cdss.ca.gov

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIRFATTAHI, ZAHRA
FACILITY NUMBER: 304313893
VISIT DATE: 07/22/2024
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Based on LPAs’ observations and interview with Zahra Mirfattahi, unlicensed care was being provided at 24092 Gemwood Drive on 07/22/24. Zahra Mirfattahi surrendered their license to the department and sent a statement of facility closure as of 07/19/24. Therefore, Zahra Mirfattahi is being cited a Type A deficiency; see attached LIC 809D for deficiency.

Exit interview conducted and report was reviewed with Zahra Mirfattahi. Appeal Rights and deficiency were discussed. Zahra Mirfattahi 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.

End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/22/2024 12:20 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 07/22/2024 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRFATTAHI, ZAHRA
FACILITY NUMBER: 304313893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/22/2024
Section Cited
HSC
1596.80

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Child day care facilities, licenses: No person... shall operate, establish, manage, conduct, or maintain a child day care facility in this state without a current valid license, therefore as provided in this act. This requirement was not met as evidenced by:
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Zahra Mirfattahi stated they will cease operation immediately. All five children were picked up by their respective parents during the visit.
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Based on LPA observation and interview, Zahra Mirfattahi confirmed unlicensed child care was being provided to children from more than 1 family at this residence, which poses an immediate risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Martha Malane
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024


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