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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417901
Report Date: 09/02/2022
Date Signed: 09/19/2022 09:51:23 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/19/2022 09:51 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:JABBARI, MICHELEFACILITY NUMBER:
013417901
ADMINISTRATOR:JABBARI, MICHELEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 525-2048
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:14CENSUS: DATE:
09/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Michele Jabbari TIME COMPLETED:
02:00 PM
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On September 2, 2022 at 1:26pm Licensing Program Analyst (LPA) Indira Loza arrived at the facility to conduct a Required Annual Inspection. LPA met with Licensee Michele Jabbari. There were no children present. LPA conducted a Health and Safety tour of the home.

Upon arrival Licensee stated that she is no longer caring for children. After LPA explained the benefits of going on Inactive, the Licensee agreed to place the License on Inactive. LPA toured the entire home and yard. There were no signs of children or childcare being provided. Licensee was advised to contact LPA when she wants to go back to Active status.

Appeal rights and notice of site visit was provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022
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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