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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423671
Report Date: 01/05/2024
Date Signed: 01/05/2024 01:48:25 PM

Document Has Been Signed on 01/05/2024 01:48 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHARIFI, SHADIFACILITY NUMBER:
013423671
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
01/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shadi SharifiTIME COMPLETED:
02:30 PM
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On 1/5/24 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection at Shadi Sharifi's family childcare home for CAPACITY INCREASE and met with Licensee, Shadi. Present in the home were Licensee, one Assistant and 5 children (3 infants, 2 preschool age). Licensee was reminded if no Assistant is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home.
Fire Clearance was granted on 10/11/23 and Licensee has met all Fire Department requirements. All licensing documents and requirements are complete. Licensee understands that parents have to be notified when providing care for more than 12 children using LIC9150 which has to be maintained in children files. Licensee understands the ratio requirements of large childcare home. Stairs and all off limit areas are gated and made inaccessible.

Areas licensed for child care: downstairs large room, bathroom, kitchenette, and sleep room. Entrance to the childcare area is through the pathway leading to side yard gate.


Outdoor On limits: Fenced backyard which is enclosed and separated from rest of the yard. No bodies of water were observed.

Facility is in compliance with Licensing requirements today and no deficiencies were cited. Technical Violation was issued for baby walkers. Facility is approved for LARGE CHILDCARE HOME. Exit interview was conducted with Licensee, Shadi Sharifi. NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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