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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629491
Report Date: 12/22/2022
Date Signed: 12/22/2022 12:35:36 PM

Document Has Been Signed on 12/22/2022 12:35 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: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:
12/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Hoseini, MaryamTIME COMPLETED:
12:15 PM
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On 12/22/2022, at 11:00AM Licensing Program Analysts (LPAs) David Miller and Vicky Williamson conducted a third pre-licensing inspection with applicant, Maryam Hoseini. The purpose of the inspection is to inspect the changes the applicant has made to the fence surrounding the pool. The applicant has used two lattice panels (one on top of each other) to meet the requirement that fences must be at least 5-feet tall as well as to ensure that a golf ball cannot fit through the gap in the lattice. In addition, the applicant used 2x2 wood boards and rubber panels to repair gaps that were larger than 4 inches on the bottom of the fence. Lastly, the four gates that open away from the pool were repaired to ensure that the gates are self latching. Even with the repairs, the fence on the East side of the backyard does not meet requirements.

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: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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