<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627395
Report Date: 08/02/2019
Date Signed: 08/02/2019 03:42:33 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:VAZIRINIA, SAYENA FAMILY CHILD CAREFACILITY NUMBER:
376627395
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
08/02/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sayena VaziriniaTIME COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst, Joelle Redding, made an unannounced visit to evaluate the facility for a requested increase in capacity from a small to a large family home. Fire clearance was received on 7/31/19.

LPA toured the home and inspected the day care areas. The roster was current and complete and children's files were reviewed. The fire extinguisher is of regulation size, operable and located under the kitchen sink. There is a newly installed smoke alarm in the child care room, family room and near the garage. The carbon monoxide detector is located in the hallway near the bedrooms.

Capacity limitations were discussed and capacity handout was provided.

Licensee has also requested that her daughter, Sahra Shirazi, who was present during this visit, be added to her Licensee. All required documentation has been received. The request to add a co-licensee and increase the capacity to a large family home is granted.

An updated copy will be mailed for posting.

Notice of Site Visit was posted today and will remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1