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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627064
Report Date: 10/15/2019
Date Signed: 10/15/2019 02:01:30 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: 0DATE:
10/15/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maryam Hoseini and Gholam GholamiTIME COMPLETED:
11:30 AM
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Regional Manager (RM) Shelley High, Licensing Program Manager (LPM) Tulam Vu, Licensing Program Manager (LPM) Joe Carassco, Licensing Program Analyst (LPA) Vicky Williamson met with Licensees Maryam Hoseini and Gholam Gholami for a Non-Compliance Conference at the San Diego Child Care Regional office (SDCCRO) on this date.

The LIC 9111 was signed and provided to Licensees Maryam Hoseini and Gholam Gholami. Licensee's daughther Zahra Gholami assisted with translating in Farsi. LPA read this report while Zahra Gholami translated in Farsi Licensees stated they understood.

This case will be referred to legal for further review.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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