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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409179
Report Date: 10/12/2022
Date Signed: 10/12/2022 05:06:49 PM

Document Has Been Signed on 10/12/2022 05:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MOKTAN, SHRADAFACILITY NUMBER:
073409179
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/12/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:32 PM
MET WITH:Shrada MoktanTIME COMPLETED:
05:15 PM
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On 10/12/22, at 4:32PM, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced on a case management inspection and met with Licensee Shrada Moktan. Upon arrival there there was one infant and one preschooler in care.

The purpose of the inspection was for an increase in capacity from a small family home to a large family day care home. LPA Fernandes did a walk through of the home and observed a pull station in the kitchen next to the sliding door. The home had an annual inspection on 8/23/22 and has been approved by the Contra Costa County Fire Protection District on 9/26/22.



The home has been approved for large capacity starting todays day.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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