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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846679
Report Date: 10/29/2024
Date Signed: 10/29/2024 10:20:27 AM

Document Has Been Signed on 10/29/2024 10:20 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ASAKEREH FAMILY CHILD CAREFACILITY NUMBER:
364846679
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Ameneh Asakereh, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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On 10/29/2024 at 09:05 AM, Licensing Program Analyst (LPA) Raymond Moorehead and Licensing Program Manager (LPM) Aaron Ross arrived at the facility to conduct a pre-licensing inspection for the purpose of a relocation. The Licensee is relocating from facility #364843794 (26403 Tangelo Way Unit 1, Loma Linda, CA 92354). Present during this inspection was Applicant Ameneh Asakereh. LPA and LPM toured the facility, inside and out. The facility is completely empty. LPA/LPM did not observe any posting, furniture, children toys or equipment. LPA/LPM informed the licensee that the home must be in compliance with Title 22 regulations and ready to provide care to children. LPA/LPM also informed the licensee that care must be provided in the unit in which the licensee resides in. The licensee stated that she is in the process of moving into Unit 2.

Before licensure, the following needs to be corrected/completed:

1. The licensee/applicant must ensure that the facility meets Title 22 regulations for licensure. LPA provided the licensee with licensing form (LIC 9217) Pre-Licensing Readiness Guide. The Licensee/Applicant must complete the form and submit it, along with pictures to the licensing agency once the facility is ready for operation.

Once all corrections have been verified, The LPA will return to the facility to complete the prelicensing inspection for a small Family Child Care Home. Applicant was advised that all corrections are due within 30 days or the application may be withdrawn.


Exit interview conducted and report was reviewed with Ameneh Asakereh, Applicant.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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