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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100829
Report Date: 12/21/2021
Date Signed: 12/21/2021 02:48:52 PM

Document Has Been Signed on 12/21/2021 02:48 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:AGHA MOHAMMADI, MAHDIE FAMILY CHILD CAREFACILITY NUMBER:
376100829
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/21/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mahdie Agha MohammadiTIME COMPLETED:
02:00 PM
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On 12/21/21, an unannounced case management visit was conducted today by Licensing Program Analyst (LPA) Michael Morales-DeSilvestore. Licensee, Mahdie Agha Mohammadi has requested an increase of capacity from having 8 children to 14 children. Fire clearance was granted on 12/13/21. Upon arrival, LPA met with Licensee and proceeded to tour the facility, inside and outside, as shown in facility sketch. There were no day care children present during the inspection.

Licensee states the following areas are used for child care: Living room 1, living room 2, bedroom 2 and bathroom 1. Off limits areas include: bedroom 1, bedroom 3 and bathroom 2. Licensee states there are no firearms or weapons in this home. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children. There is a working fire extinguisher, a smoke detector, carbon monoxide detector; and there is adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone/email address. Facility has a back yard for outdoor play. There are no excluded individuals present at this home. Pediatric CPR/First Aid are current with an expiration date of February 2022. LPA Morales-DeSilvestore reviewed ratio/capacity limitations, supervision, physical plant, reporting requirement, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, emergency drills and child care roster. LPA reminded Licensee that walkers, jumpers, exersaucers and bouncers are not permitted for use in the day care.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: AGHA MOHAMMADI, MAHDIE FAMILY CHILD CARE
FACILITY NUMBER: 376100829
VISIT DATE: 12/21/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

***Capacity increase of a large FCCH license is granted and effective today’s date, 12/21/21.

No deficiencies observed in the areas inspected during today's visit.
NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
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