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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701134
Report Date: 07/25/2024
Date Signed: 07/25/2024 10:25:48 AM

Document Has Been Signed on 07/25/2024 10:25 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:
07/25/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Zahra Hosseinmighadam- ApplicantTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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On 7/25/24, Licensing Program Analyst Briana Plumboy, met with applicant Zahra Hosseinmoghadam for an ANNOUNCED PRE LICENSING INSPECTION. The home was toured to inspect the missing items from 7/2/24 and backyard. Present at the facility during today's inspection was Zahra Hosseinmighadam & Gholamhossein Hosseinmoghadam. The applicants plan to operate the facility 7 days a week from 5:00am until 11:00pm.

The OFF LIMIT AREAS are the 2 bedrooms (bedrooms #2 & #3), kitchen/dining area, master bedroom with bathroom (located off the kitchen), 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 (first bedroom on right side of hallway). The ISOLATION AREA will be bedroom #1. Outdoor play area will be in the backyard (the applicants will escort the children at all times to the backyard providing 100% visual and physical supervision due to the kitchen/dining room being an off limit area for applicants to provide care. The children may only walk through the kitchen/dining room area to access the backyard and at no time shall this area be used for care. The children in care can utilize the fenced in area only located down 2 steps from the dining room, off to the right of the home and behind the home. The children in care will not utilize either driveway on the sides of the home or the outside area located around the ADU unit/ top level of the backyard). During today's inspection, the play area for children in care is fenced in with child safety gates.

On 7/2/24, a Prelicensing inspection was conducted and the home was not recommended for licensing until the following was 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)

During today's inspection, the applicants have made the corrections to their home and obtained the items needed to operate a family childcare home.

This home is recommended for licensing on 7/25/24. This report shall remain on file for 3 years. Exit interview conducted applicant.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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