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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314112
Report Date: 10/15/2024
Date Signed: 10/16/2024 11:36:38 AM

Document Has Been Signed on 10/16/2024 11:36 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 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: 0CENSUS: 4DATE:
10/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Akhavan, MahjabinTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
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On 10/15/2024, Licensing Program Analysts (LPAs), Jung and Tran conducted a Case Management – Other visit. At 3:00PM, LPAs arrived at 4062 Escudero Drive, Irvine to conduct surveillance.

Around 5:30PM, LPAs observed Adult 1 (A1) arrive at the facility and pick up two children. Around 5:45PM, LPAs observed Adult 2 (A2) pick up one child. At 5:47PM, LPAs observed Adult 3 (A3) pick up one child. At 5:50PM, LPAs observed the licensee exit the facility and walk toward their vehicle. LPAs approached the licensee and spoke to them regarding the children who were observed being picked up from the facility.

Licensee had previously provided a letter to the Department stating that they were surrendering their Family Child Care Home license. However, on 10/15/2024, they were observed to be providing care to children from more than one family. On 10/15/2024, licensee told LPAs that they would call the parents of all enrolled children to notify them of the facility's closure and would cease operation beginning 10/16/2024.

Licensee refused to sign or accept a report from the LPAs regarding the visit. LPA Jung emailed the report to the licensee.

End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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