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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628149
Report Date: 03/30/2023
Date Signed: 03/30/2023 03:01:37 PM

Document Has Been Signed on 03/30/2023 03:01 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RANJBAR, SHAHLA FAMILY CHILD CAREFACILITY NUMBER:
376628149
ADMINISTRATOR:SHAHLA RANJBARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 295-5230
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Shahla RanjbarTIME COMPLETED:
03:15 PM
NARRATIVE
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On 3/30/23 at 1:48 PM Licensing program Analyst (LPA) Adrian Mangina and Licensing Program Manager (LPM) Renesha Askew conducted a Case Management inspection for the purpose of delivering an amended report. Upon arrival LPA and LPM observed that there were 9 children in care present in the home. Licensee stated that Assistant/spouse Joe Shegarfi was out and was expected to be back in ten minutes. Facility was out of ratio as no assistant was present. Assistant arrived at the home at approximately 2:10 PM. At approximately 2:32 pm two children left the facility and one left at 2:38 with authorized representatives.

During the visit, LPA and LPM provided Licensee, Shahla Ranjbar with an amended copy of a LIC809 Facility Inspection Report dated 2/27/23, capacity and resources handout. Licensee was reminded that off limit areas must remain inaccessible at all times. That baby walker/rockers and the like are not permitted and must remain inaccessible, the home is to be clean and orderly when children are in care, that new children must have a complete file upon first day in care and to keep children's roster updated.

LPA Mangina informed facility representative Shahla Ranjbar that this report dated 3/30/23 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. See LIC809 D for Type A deficiency cited.

Also, LPA Mangina informed the facility representative to provide a copy of this licensing report dated 3/30/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Licensee, Shahla Ranjbar and a copy of this report was given to the licensee. A Notice of Sight Visit was also provided and must be posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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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Document Has Been Signed on 03/30/2023 03:01 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/30/2023 at 01:59 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: RANJBAR, SHAHLA FAMILY CHILD CARE
FACILITY NUMBER: 376628149

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2023
Section Cited
CCR
102416.5

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STAFFING RATIO AND CAPACITY: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home...
This requirement was not met as evidenced by:
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Assistant arrived at the facility at approximately 2:10 PM. Licensee states she will ensure to revert to the capacoty of a small license whenever alone with children in care.
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Based on observation and interview, Licensee was alone in the home with nine children: two infants, six prescoolers and one school-aged child, which poses an immediate health, safety and personal rights risk to individuals 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:Renesha Askew
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2023


LIC809 (FAS) - (06/04)
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