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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314112
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:26:51 PM

Document Has Been Signed on 08/08/2024 04:26 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:AKHAVAN, MAHJABINFACILITY NUMBER:
304314112
ADMINISTRATOR/
DIRECTOR:		AKHAVAN, MAHJABINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 742-2581
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Licensee relative - JessicaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 08/08/24 at 2:10PM, Licensing Program Analyst (LPA), Christine Jung made an unannounced visit to the facility.

Upon arrival, LPA rang the doorbells which were located on the outside of the front gate, but there was no response. LPA called the licensee at the provided number, but the licensee did not answer. The licensee's voice mailbox was full, so LPA could not leave a voicemail. At 2:13PM, LPA entered through the gate and knocked on the front door. LPA observed an individual with a child on their hip come to the door then walk away.

The individual returned and open the door ajar to greet the LPA. The individual stated their name is Jessica, and they are the licensee's daughter-in-law. Jessica stated the facility was not providing child care on this date, and the licensee was not present due to a doctor's appointment. LPA asked whether the licensee notified the Regional Office (RO) regarding the day's closure. Jessica stated that the licensee was not aware of this policy. Jessica also stated they were taking care of their own daughter and their neighbor's child from their own neighborhood on this date.

Since the licensee did not notify the RO regarding the closure of facility on this date, LPA notified Jessica of the department's right to enter a licensed child care facility during operating hours. Jessica stated they needed to confirm LPA's identity since they are not the owner of the home. LPA provided Jessica a business card to call RO. Jessica closed the door and went inside to make the call.

When Jessica returned, they stated they had spoken with the licensee and both the licensee and herself were upset about the visit because they have been frequently visited by licensing in the recent past. They stated the licensee has never been told of the policy to notify RO if the facility is closed for any reason.
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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: AKHAVAN, MAHJABIN
FACILITY NUMBER: 304314112
VISIT DATE: 08/08/2024
NARRATIVE
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(Page 2)
They also stated they were present during a past visit when the facility was closed for a week. They recall being told by the LPA that visited, that the department is not allowed to enter if the facility is closed. According to Jessica, this LPA did not disclose that licensee needs to notify RO of any closures.

LPA asked Jessica to notify licensee of the visit and reiterated the department's right to enter the facility during operating hours. However, Jessica did not give LPA permission to enter the home. LPA notified Jessica that the department shall assess an immediate civil penalty of five hundred dollars ($500) for refused entry to the facility; see LIC 809D for deficiency cited.

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

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/08/2024 04:26 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 08/08/2024 at 03:37 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: AKHAVAN, MAHJABIN
FACILITY NUMBER: 304314112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2024
Section Cited
HSC
1596.99(c)(6)

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ยง1596.99 Levy of civil penalty in addition to suspension, temporary suspension, or revocation; amounts; regulations setting forth appeal procedures for deficiencies: (6) Refused entry to a facility or any part of a facility in violation of Section 1596.852, 1596.853, or 1597.09.
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Licensee was not present at the facility to provide a plan of correction.

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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: 08/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024


LIC809 (FAS) - (06/04)
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