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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407754
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:39:19 PM


Document Has Been Signed on 07/27/2023 03:39 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:TALEBZADEH, TARAFACILITY NUMBER:
073407754
ADMINISTRATOR:TALEBZADEH, TARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 812-1434
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:14CENSUS: 7DATE:
07/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Tara TalebzadehTIME COMPLETED:
02:30 PM
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On 7/27/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection for ROOM ADDITION. LPA met with Licensee, Tara Talebzadeh. Present in the home were 7 children (2 infants, 5 preschool age).

Licensee had requested to add attached Garage converted into day care room. Licensing Office requested a fire clearance for the garage. Fire inspection was conducted on 7/26/23 and clearance was denied by the Contra Costa Fire Department. Licensee now wants to add the Master Bedroom to On Limit Area and use it for infant naptime. LPA inspected the bedroom and observed a crib with mattress and fitted sheet. All items dangerous to health and safety of children were inaccessible in the room. The Master Bathroom attached to this bedroom will remain off limit and LPA observed a child proof lock on the bathroom door.

Master Bedroom is approved for use as On Limit Area of the day care.

Effective today day care's In Use and Off Limit areas will be as follows:
In Use Areas: Family room, Living room (naps), Bedroom #2 (naps), Laundry room, Bathroom next to Laundry, Master Bedroom (for infant nap)
Off Limit Areas: Office/Bedroom#1, Bedroom #3, Kitchen, Dining area, Master Bathroom, Bathroom in Hallway next to Master bedroom, Attached Garage.

This report was reviewed with Licensee, Tara Talebzadeh. NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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