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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629491
Report Date: 12/14/2022
Date Signed: 12/14/2022 10:18:55 AM

Document Has Been Signed on 12/14/2022 10:18 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GHOLAMI, GHOLAM & HOSEINI, MARYAM FCCFACILITY NUMBER:
376629491
ADMINISTRATOR:GHOLAM G. & MARYAM H.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 212-3841
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maryam Hosein TIME COMPLETED:
10:15 AM
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On 12/14/2022, at 8:45AM Licensing Program Analysts (LPAs) David Miller and Vicky Williamson conducted a second pre-licensing inspection with applicant, Maryam Hosein. The purpose of the inspection is to review the proposed fence plan for the in-ground swimming pool. LPA reviewed and provided the applicant with Title 22 regulation, Section 102417(g)(5) states “Licensees shall ensure the inaccessibility of pool through a pool cover or by surrounding the pool with a fence. Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code."

Photos were taken during the inspection. Applicant will contact the LPA once the pool meets Title 22 regulation for a final pre-licensing inspection.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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