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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406962
Report Date: 03/01/2024
Date Signed: 03/01/2024 12:22:29 PM


Document Has Been Signed on 03/01/2024 12:22 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:HABIBI, FARIDEHFACILITY NUMBER:
073406962
ADMINISTRATOR:HABIBI, FARIDEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 231-5924
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:14CENSUS: 6DATE:
03/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:FARIDEH HABIBITIME COMPLETED:
12:30 PM
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On March 1, 2024 at 12:00 PM Licensing Program Analyst (LPA) Tasha Alexander met with Licensee Farideh Habibi to clear deficiencies cited during a compliant investigation on 2/7/24. During that visit, the licensee was operating out of ratio.

Today upon arrival there are 6 preschool age children present along with licensee. Today the facility is operating within ratio and capacity. It is also noted that, the licensee's daughter's finger prints are now fully cleared and she can now work as the licensee's assistant.

Today the citation will be cleared.

An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 725-2831
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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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