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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503904174
Report Date: 10/26/2023
Date Signed: 10/26/2023 02:11:22 PM

Document Has Been Signed on 10/26/2023 02:11 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:KHOSHABA, NAHRAIN FAMILY CHILD CAREFACILITY NUMBER:
503904174
ADMINISTRATOR:KHOSHABA, NAHRAINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 622-0244
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
10/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Nahrain KhoshabaTIME COMPLETED:
02:15 PM
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On October 26, 2023, Licensing Program Analysts Anita Tristan, Stephanie Vega-Gonzalez and Licensing Program Manager Cynthia Brannon conducted a case management inspection to ensure Nahrain Khoshabe is not providing care to children.

During today's inspection, Nahrain Khoshaba informed LPM that she is not providing child care. Her daughter is proving care to one child through the Stanislaus County of Education. Per her daughter, she will be providing care to the child's home once she is accepted into the program.

Exit interview conducted and report was reviewed with Nahrain Khoshaba. No deficiencies were issued during today's inspection.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Anita Tristan
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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