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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623899
Report Date: 03/29/2021
Date Signed: 03/29/2021 09:08:30 AM

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:AOUF, NESRINFACILITY NUMBER:
343623899
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
03/29/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Nesrin AoufTIME COMPLETED:
09:30 AM
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NOTE: Due to COVID19 pandemic and DPH guidelines on physical distancing, a Tele-visit via FaceTime is being conducted.
On Monday, March 29, 2021, at approximately , Licensing Program Analyst (LPA) Marea Behvand met with Nesrin Aouf (Licensee) via FaceTime for the purpose of conducting a Change of Location prelicensing tele-inspection. With the help of Applicant, a health and safety inspection of all areas accessible to children was conducted. The one story house consists of: Master Bedroom #1 and en-suite Master Bathroom #1, Bathroom #2, Bedroom #2, Bedroom #2, Living Room, Kitchen, Dining Room, Garage, and Backyard. The off-limits areas in the home will consist of Master Bedroom #1 and en-suite Master Bathroom #1, Bedroom #3, and garage. Off-limit areas will remain inaccessible to children by closed doors and/or supervision. Licensee acknowledged that children may never enter these off-limit areas. Current CPR/First Aid certificates (expires: 11/17/2023), posted License, Parent's Rights, Emergency Disaster Plan, Roster of the enrolled children, and Fire Drill Log are all being maintained by the Licensee. Hazardous items were stored inaccessible to children in care. ns. Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. Toys appear to be safe. The backyard is fenced. The Licensee understands that in unfenced areas 100% supervision of children is required. 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 tele-visit.
Effective, Monday March 29, 2021, The facility is licensed to serve a MAX. CAP of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.
This report (LIC809) and Appeal Rights will be delivered to the Applicant electronically via email.
Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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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