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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627064
Report Date: 02/04/2020
Date Signed: 02/04/2020 05:42:24 PM

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:GHOLAMI, GHOLAM & HOSEINI, MARYAM FCCFACILITY NUMBER:
376627064
ADMINISTRATOR:MARYAM H,& GHOLAMI GHOLAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 792-8995
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:14CENSUS: 5DATE:
02/04/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:31 PM
MET WITH:Maryam Hoseini and Gholam GholamiTIME COMPLETED:
05:45 PM
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Licensing Program Analysts (LPAs) Selina Siao and Tyra Block conducted a case management inspection to ensure that the facility is within compliance with licensing regulation along with the requirements indicated on the noncompliance conference held in the SDCCRO on 10/15/2019.

Upon arrival, licensee's minorson and daughter in law Fatema Rezaee was at the home. Licensee Maryam Hoseini arrived at the home with four day care children and co-licensee Gholam Gholami arrived to the home within 5 minutes from each other.

Licensee's daughter Zahra Gholami provided with translation over phone during the inspection. Licensee's daughter stated that the required items listed on the non compliance plan was previously submitted to licensing.

LPA provided the facility with a facility's daily sign in and out sheet for the children in care and self assessment guide.

Four of the children's files were reviewed today.


This licensing report was translated to licensee and co-licensee by their son Hosein Gholami in Farsi.

Notice of site visit was posted during today's inspection and it must be remain posted for up to 30 days to avoid civil penalty of $100.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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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