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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701134
Report Date: 07/02/2024
Date Signed: 07/02/2024 11:28:02 AM

Document Has Been Signed on 07/02/2024 11:28 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HOSSEINMOGHADAM, ZAHRA & KOLMER, NARGESFACILITY NUMBER:
015701134
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/02/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Zahra Hosseinmighadam & Narges Kolmer- ApplicantsTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 7/2/24, Licensing Program Analyst Briana Plumboy, met with applicants Zahra Hosseinmoghadam & Narges Kolmer for an ANNOUNCED PRE LICENSING INSPECTION. The home was toured to conduct a Health and Safety Inspection. Currently residing in the home are applicants Zahra Hosseinmoghadam & Narges Kolmer, Gholamhossein Hosseinmoghadam (Zahra's father & Narges husband), and Monica Devi (tenant). At this time there are no children residing in the home. The applicants plan to operate the facility 7 days a week from 5:00am until 10:00pm.
The home is single story. The home consists of a living room, hallway bathroom, 3 bedrooms, kitchen/dining area, master bedroom with bathroom, and ADU unit located in the backyard (not permitted by the city). The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the 2 bedrooms (bedrooms #2 & #3), kitchen/dining area, master bedroom with bathroom, and ADU unit which will be inaccessible by closed doors and visual supervision. The ON LIMIT AREAS are the living room, hallway bathroom, and bedroom #1. The ISOLATION AREA will be bedroom #1. Outdoor play area will be in the backyard. The backyard is not set up or ready for childcare during today's inspection, and will be inspected upon LPA Plumboy's follow up inspection. There is not a sufficient amount of child toys or learning materials available during today's inspection. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Both applicant’s Health and Safety training is completed and CPR and First Aid certificates are current. Zahra Hosseinmoghadam's CPR/First Aid certificate expires 2/5/26 & Narges Kolmer's CPR/First Aid certificate expires 2/7/26. The applicants completed and received certificates in mandated reporter training both on 5/16/24. The applicants are in compliance with immunization law which pertains to day care providers. The floor heaters must be screened to prevent access by children, and LPA Plumboy will follow up with applicants at the next inspection. Per applicants, there are no firearms in the home. A copy of the mortgage statement was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.
See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HOSSEINMOGHADAM, ZAHRA & KOLMER, NARGES
FACILITY NUMBER: 015701134
VISIT DATE: 07/02/2024
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The applicants are reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. There is an ADU unit being constructed and applicants are aware while construction is occurring, children in care may not be outside in the backyard, and all equipment must be inaccessible to children in care. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

LPA discussed the safe sleep regulations with applicants Zahra Hosseinmoghadam & Narges Kolmer and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Subscribe to CCLD important information - Child Care Centers and Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The applicants Zahra Hosseinmoghadam & Narges Kolmer were reminded nothing shall hang over the infant cribs and not to swaddle infants while in care.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HOSSEINMOGHADAM, ZAHRA & KOLMER, NARGES
FACILITY NUMBER: 015701134
VISIT DATE: 07/02/2024
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Applicants are reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicants were reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

Applicants Zahra Hosseinmoghadam & Narges Kolmer are aware they should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.


During the exit interview, the applicants Zahra Hosseinmoghadam & Narges Kolmer confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

This home is NOT recommended for licensing until the following is completed.
1) The applicants must obtain toys/ learning materials to meet the needs of children if they were in care
2) Floor heaters must be covered
3) The backyard must be set up free from defects and dangerous conditions
4) All toxins and hazardous items must be inaccessible to children in care
5) The applicant needs to obtain at least 1 crib per infant if they plan to care for infants (Children under the age of 2)

The applicants are aware the signature on this report confirm receipt of these documents. LPA asked the applicants if the applicants had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the applicants, and per applicants, there are no further questions at this time. Applicants are aware at anytime they can reach out to LPA Plumboy or CCLD. Appeal rights provided and discussed. This report shall remain on file for 3 years. Exit interview conducted applicants Zahra Hosseinmoghadam & Narges Kolmer.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
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