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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623379
Report Date: 08/03/2020
Date Signed: 08/03/2020 02:40:11 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:GOODARZI, AZARDOKHTFACILITY NUMBER:
343623379
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
08/03/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Azardokht GoodarziTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Kelly Ferrara contacted Licensee Azardokht Goodarzi to conduct a Change of Capacity tele-inspection. The Licensee is requesting an increase from eight to 14 children. Today's census was eight children.

LPA Ferrara received proof of eligible qualifications for the Licensee to increase the capacity of her home. LPA was able to review the assistant's files and all the required paperwork was observed.

Off-limit areas include: Garage and entire upstairs. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a pull fire alarm, mounted fire extinguisher, and new front door handle. LPA observed a functioning smoke alarm and carbon monoxide detector.

A Fire Safety Inspection Clearance has been received from the Folsom Fire department and the home has been cleared for up to 14 children.

Applicant is now approved to operate as a Large Family Child Care Home as of today, August 3rd, 2020. Facility is now licensed to serve a maximum capacity (when there is an assistant present) of 12 children with no more than four infants OR a capacity of 14 children no more than three Infants; one child must be in Transitional Kindergarten/Elementary School and one child must be at least six years old. If there is not an assistant present, the facility must revert to a Small Family Child Care Home license.

A copy of this report was emailed to the applicant along with the most recent guidelines for child care facilities during the Covid-19 pandemic.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020
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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