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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623077
Report Date: 04/23/2020
Date Signed: 04/23/2020 03:29:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MINOIEFAR, ZOHREHFACILITY NUMBER:
343623077
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
04/23/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Zohreh MinoiefarTIME COMPLETED:
02:45 PM
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*Tele-visit completed via facetime for the capacity increase due to COVID-19 State Of Emergency*

On April 23, 2020, at approximately 2:00 PM, Licensing Program Analyst (LPA) Lea Habtom conducted a Case Management tele-visit for the purpose of an increase in capacity from 8 to 14 children. LPA informed the licensee, Zohreh Minoeifar, of the reason for the inspection. There were four children present at the time of the tele-visit inspection ages of 10 months, 2, 3 and 4 supervised by licensee and her spouse, Hashem Khorasani. Licensee stated there are no new residents in the home. All adult residents have criminal record clearances.

LPA initiated a health and safety inspection of all areas accessible to children.

Off-limits areas include the kitchen, living room, dinning room, laundry room, master bedroom, two spare bedrooms and backyard. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed current CPR/First Aid certificates (expires: 3/2022), posted License, Parent's Rights and current emergency disaster plan.

The Fire Safety Inspection Clearance has been received and the home has been cleared for up to 14 children.

Hazardous items were stored inaccessible to children in care.

Licensee stated there are no weapons in the home.

809-C on next page
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MINOIEFAR, ZOHREH
FACILITY NUMBER: 343623077
VISIT DATE: 04/23/2020
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Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation.

Toys appear to be safe.

There are no bodies of water on the premises.

Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Capacity increase is approved as of 4/23/2020.

The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

LPA reviewed and discussed this facility evaluation report with the Licensee.

Notice of site visit posted.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2020
LIC809 (FAS) - (06/04)
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