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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624230
Report Date: 05/19/2022
Date Signed: 05/19/2022 03:33:30 PM

Document Has Been Signed on 05/19/2022 03:33 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:HASSANZADAH, SOODABAHFACILITY NUMBER:
343624230
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Soodabah HassanzadahTIME COMPLETED:
03:45 PM
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At 3:00 p.m. on Thursday, May 19, 2022, Licensing Program Analyst (LPA) Amanda Sutter met with Applicant, Soodabah Hassanzadah, for the purpose of a prelicensing inspection. An initial inspection was conducted on May 16, 2022. Applicant submitted proof of the fireplace in the backyard properly barricaded. LPA conducted a health and safety inspection for needed corrections prior to licensure. LPA observed that the debris in the backyard was properly barricaded. LPA observed the fountain with a cover that meets regulations.

As of today 5/19/2022, facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2022
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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