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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701134
Report Date: 06/15/2026
Date Signed: 06/15/2026 02:22:26 PM

Document Has Been Signed on 06/15/2026 02:22 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HOSSEINMOGHADAM, ZAHRAFACILITY NUMBER:
015701134
ADMINISTRATOR/
DIRECTOR:		HOSSEINMOGHADAM, ZAHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 716-9465
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
06/15/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Narges Kolmer- AssistantTIME VISIT/
INSPECTION COMPLETED:
02:37 PM
NARRATIVE
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On 6/15/26 at 10:55am, Licensing Program Analyst Briana Plumboy, met with applicant Zahra Hosseinmoghadam for an UNANNOUNCED CASE MANAGEMENT INSPECTION. Present for this visit was 6 infants, 2 preschool age child, S1, and S2. At 10:55am, LPA Plumboy observed 8 children in care. Licensee left the facility at 12:34pm due to an emergency and left S2 in charge of the childcare. Applicants primary language is Farsi. This report was translated using Interpreting Services with translator # 98473367.The home was toured.
The inspection was conducted to remove the front yard from being included in the on limit areas of the childcare. The front yard is no longer set up for childcare. As of 6/15/26, the front yard is a driveway and not included as part of the childcare.
During today's inspection, at 10:55am, LPA Plumboy observed 8 children in care consisting of 6 infants and 2 preschool age children. The licensee is out of ratio during today's inspection. Licensee will email LPA Plumboy once she is back in compliance with ratio and LPA Plumboy will conduct a follow up inspection. Licensee will also notify LPA Plumboy her plan for maintaining ratio and a schedule consisting of the children's names and which days of the week they will be in care in order for her to come back into compliance.
The attached Type A deficiency is cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file. See 809-D for deficiency cited during today's inspection. The assistant is aware the signature on this report confirm receipt of these documents. LPA asked the assistant if the assistant had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the assistant, and per assistant, there are no further questions at this time. Appeal rights provided and discussed. This report shall remain on file for 3 years. Exit interview conducted with assistant S2.
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Briana Plumboy
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/15/2026 02:22 PM - It Cannot Be Edited


Created By: Briana Plumboy On 06/15/2026 at 01:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HOSSEINMOGHADAM, ZAHRA
FACILITY NUMBER: 015701134

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2026
Section Cited
CCR
102416.5(d)(1)

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102416.5 Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:(1) Twelve children, no more than four of whom may be infants; or
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On or before 6/15/26, Licensee must reduce the amount of infants she has in care and maintain the ratio specified on license. LPA to revisit to ensure Licensee is remaining within ratio.
Licensee will also notify LPA Plumboy her plan for maintaining ratio and a schedule consisting of the children's names and which days of the week they will be in care in order for her to come back into compliance.
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The following deficiencies were observed during today's inspection:
At 10:55am, LPA observed 6 infants and 2 preschool age children in care.
This requirement was not met as evidenced by the licensee is operating out of ratio which poses an immediate health and safety risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.



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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Briana Plumboy
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2026


LIC809 (FAS) - (06/04)
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