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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701134
Report Date: 09/12/2024
Date Signed: 09/12/2024 11:33:57 AM

Document Has Been Signed on 09/12/2024 11:33 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:
09/12/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:08 AM
MET WITH:Zahra Hosseinmighadam- LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 9/12/24 at 11:08am, Licensing Program Analyst Briana Plumboy, met with licensee Zahra Hosseinmoghadam for an UNANNOUNCED CASE MANAGEMENT INSPECTION. The home/yard was toured. Present at the facility during today's inspection was Zahra Hosseinmighadam & licensee's fingerprint clear and associated father Gholamhossein Hosseinmoghadam.

The licensee initiated the case management inspection in order to change the play area from the backyard to the frontyard. Upon inspection during today's visit, the frontyard is not ready to be utilized if children were in care and not approved as an on limit area. Licensee is aware when the front yard is completely ready for usage by children and child safe, she may reach out to LPA Plumboy and ask for an additional inspection to have her front yard reinspected to be included in the "on limits" areas.

There were no deficiencies issued today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Zahra Hosseinmoghadam.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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