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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408266
Report Date:
06/07/2022
Date Signed:
06/07/2022 04:13:44 PM
Document Has Been Signed on
06/07/2022 04:13 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:
GOLESTAN
FACILITY NUMBER:
073408266
ADMINISTRATOR:
DELAVARIAN, MICHKA
FACILITY TYPE:
850
ADDRESS:
320 SAN CARLOS AVE
TELEPHONE:
(510) 616-2802
CITY:
EL CERRITO
STATE:
CA
ZIP CODE:
94530
CAPACITY:
45
TOTAL ENROLLED CHILDREN:
34
CENSUS:
27
DATE:
06/07/2022
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Yalda Modabber and Pegah Afkary
TIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta completed a Case Management Annual Continuation on 6/7/22.
An annual required inspection was completed 9/10/21. During the inspection on 9/10/21 a Type A citation was issued for the facility not having a qualified teacher present in the classroom caring for children. The facility appealed the citation. As a result of the appeal process the citation issued on 9/10/21 is reduced to a Type B citation.
This report was reviewed over the telephone with Yalda Modabber and Pegah Afkary. A copy of the report will be emailed to the facility.. It is agreed that the report will be signed and returned to CCL by 6/8/22.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
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
2
Document Has Been Signed on
06/07/2022 04:13 PM
- It Cannot Be Edited
Created By:
Cherie Acosta
On
06/07/2022
at
02:27 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, SUITE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
GOLESTAN
FACILITY NUMBER:
073408266
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(c)(1)
Teacher Qualifications and Duties
(c) To be a fully qualified teacher, a teacher shall have one of the following: (1) Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that facility classroom did not have a qualified teacher during the inspection which poses/posed a potential health and safety risk to persons in care.
POC Due Date:
06/07/2022
Plan of Correction
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3
4
Citation is cleared
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Sherelle Johnson
LICENSING EVALUATOR NAME:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE:
06/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/07/2022
LIC809
(FAS) - (06/04)
Page:
2
of
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