015701134-8-12-2025-52-CC-BPLY-DKGLQM-20250812085748

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015701134
Report Date: 08/12/2025
Date Signed: 08/12/2025 08:57:55 AM

Document Has Been Signed on 08/12/2025 08:57 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, NARGES		FACILITY NUMBER:	015701134
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 4	DATE:	08/12/2025
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Zahra Hosseinmighadam & Narges Kolmer- Licensees		TIME VISIT/ INSPECTION COMPLETED:	09:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/12/25, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Case Management Inspection with Licensees Zahra Hosseinmighadam & Narges Kolmer. Present for the inspection was 4 children in care (3 infants and 1 preschool age child). The home was toured with the the licensees to conduct a health and safety inspection. The licensee's operate the facility 7 days a week from 5:00am until 10:00pm. On 08/07/25, a fire clearance was granted to facility #015701134 by Alameda County Fire Department. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant or additional licensee is needed with a large family child care home license, and whenever an assistant or additional licensee is not present, the licensees will comply with the capacity requirements for a small family child care home. Approved 850 received. Comments, "Fire Clearance Granted. Note Update Facility Sketch reflecting living room, all bedrooms, bathroom #1, and kitchen is off limits to children" CHILDREN IN CARE MAY ONLY UTILIZE THE DAYCARE ROOM & BATHROOM IN THE DAYCARE ROOM WHICH IS THE ROOM LOCATED IN THE BACK OF THE HOME OFF THE DINING ROOM AREA, AND THE DINING ROOM AREA ONLY. THERE IS A BARRIER IN PLACE DURING TODAY'S INSPECTION WHICH PREVENTS ACCESS TO THE KITCHEN AND REMAINDER OF THE HOME WHICH IS OFF LIMITS TO CHILDREN IN CARE AT ALL TIMES. See 809-C for continuance

NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Briana Plumboy
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

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

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 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: 08/12/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The ISOLATION AREA will be the dining area. 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. The FRONTYARD play area is fenced. There are toys and learning materials that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that during the inspection there are no toxins or hazardous items accessible.

There is a fire extinguisher, carbon monoxide detector, pull down fire alarm, and smoke detector which meet State Fire Marshall standards during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Both licensee’s Health and Safety training are 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 licensee's completed and received certificates in mandated reporter training both on 5/16/24.

Licensees 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. Licensees are reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .

As of 8/12/25, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensees were reminded to have it posted for 30 days. This entire report has been read to the Licensees by LPA Plumboy. The licensees are aware the signature on this report confirms receipt of these documents. LPA asked the licensees if the licensees have any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensees, and per licensees, there are no further questions at this time. Licensees are aware at anytime they can reach out to LPA Plumboy or CCLD. An exit interview was conducted, and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Briana Plumboy
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3