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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418111
Report Date: 10/11/2023
Date Signed: 10/11/2023 11:55:35 AM


Document Has Been Signed on 10/11/2023 11:55 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:MASOOD, SOFIA & SOHNIFACILITY NUMBER:
013418111
ADMINISTRATOR:MASOOD, SOFIA & SOHNIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 825-3099
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 8DATE:
10/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Sofia MasoodTIME COMPLETED:
12:00 PM
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On 10/11/2023 Licensing Program Analysts (LPAs) Randall Dunevant and Briana Plumboy arrived at the facility for an unannounced case management visit. LPAs met with licensee Sofia Masood and discussed the purpose of todays visit to take the licensee off of required visits. Present during todays visit is assistant Monowara Begum, 7 preschool age children, and 1 infant in care. Effective 10/11/2023 the facility is removed from required visits.

An exit interview was conducted with licensee Sofia Masood. A notice of site visit given and must be posted for 30 days.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Randall DunevantTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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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