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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701134
Report Date: 10/17/2024
Date Signed: 10/17/2024 10:49:01 AM

Document Has Been Signed on 10/17/2024 10:49 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: 5CENSUS: 0DATE:
10/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Zahra Hosseinmighadam & Narges Kolmer- LicenseesTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 10/17/24 am at approximately 10:35am, Licensing Program Analyst Briana Plumboy, met with licensees Zahra Hosseinmighadam & Narges Kolmer for an UNANNOUNCED CASE MANAGEMENT INSPECTION. Also present for the inspection was Gholamhossein Hosseinmoghadam (Zahra's father & Narges husband) whom is fingerprint cleared and associated. The yard was toured.

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 ready to be utilized by children in care and included in the on limit areas.

The OFF LIMIT AREAS are the 2 bedrooms (bedrooms #2 & #3), kitchen/dining area, master bedroom with bathroom (located off the kitchen), backyard, and ADU unit which will be inaccessible by closed doors and visual supervision. The ON LIMIT AREAS are the living room, hallway bathroom, frontyard, and bedroom #1 (first bedroom on right side of hallway). The ISOLATION AREA will be bedroom #1. Licensees are aware when children play in the front yard there must be 100% physical and visual supervision on the children in care at all times.

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: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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