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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100360
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:47:01 PM


Document Has Been Signed on 05/25/2022 02:47 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:DIZAYI, ROZHAN FAMILY CHILD CAREFACILITY NUMBER:
376100360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/25/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Licensee, Rozhan Dizayi TIME COMPLETED:
11:05 AM
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Licensing Program Analyst, Jennifer Lott conducted an announced Case Management visit for an increase in capacity from eight (8) to fourteen (14) children. LPA was greeted at the front door by Licensee, Rozhan Dizayi and granted entry after identifying herself and disclosing the purpose of her visit. Currently in care were 3 children.

On 04/15/2022, the licensee submitted an application (LIC 279) to request an increase of capacity. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal and granted the capacity increase to fourteen (14) children on 04/22/22.
LPA conducted an inspection of home which includes 4 bedrooms and 2 bathrooms with an attached garage. Licensee will be using kitchen, living room, yard #2, bedroom #1 & bathroom #1 for child care. Off limit areas include garage, front yard, yard #1, bedrooms 2-4 and bathroom #2. Smoke alarms and carbon monoxide detector are functional and meet statutory requirements. Fire extinguisher is located in the kitchen and has been serviced. There is an above ground pool that is empty and surrounded by a 5ft fence that swings away from the pool meeting statutory requirements.

LPA discussed the following with the applicant: Maximum capacity for a large family child care home; 12 children with no more than 4 infants (infants defined as children under 24 months) or 14 children with no more than 3 infants, and one child enrolled in kindergarten and one child at least 6 years old. When there is no qualified assistant, 14 years of age or older present, the capacity reverts back to requirements for a Small Family Child Care Home. You must notify parents if you care for more than 12 children (LIC 9150). Additionally, information was provided on safe sleep concepts.

No deficiencies were cited during today’s visit. A license for a capacity of fourteen (14) will be issued after final file review. An exit interview was conducted the report was reviewed with licensee, Dizayi. A notice of site visit was given and most remain posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
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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