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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409455
Report Date: 04/04/2024
Date Signed: 04/04/2024 03:46:13 PM

Document Has Been Signed on 04/04/2024 03:46 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LOTFY REZVANI, MANAFACILITY NUMBER:
073409455
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
04/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Mana Lotfy RezvaniTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 4/4/2024 Licensing Program Analysts (LPAs) Brindha Govindasamy and Monica Mathur conducted an unannounced case management – CAPACITY INCREASE for large family child care home. LPA met with licensee, Mana. During today's inspection, there were 7 children in care (1 Infant, 4 preschool and 2 school age children). Family members residing in the home are licensee and licensee's husband. Day care was in ratio compliance during today's inspection. Fire clearance was approved on 3/21/2024.

There is a fully charged 3A40BC fire extinguisher, working dual smoke and carbon monoxide detector. LPA observed cleaning products under the sink, sharp objects on the counter top in the kitchen were accessible to children. Licensee removed knifes and locked the cabinet that stored cleaning products. Technical violation was given for accessibility to hazardous items in day care use area. Children were not present in the area at time of inspection.

LPA observed structural changes have been made by removing a wall dividing previous dining room and Bedroom #2 and converted into a large Living room #1 for day care use. Children were napping in the room at time of inspection. It was noted that Licensee did not notify CCLD office about structural changes. In the pre licensing report of 9/27/23 Licensee was reminded about contacting CCLD prior to making any structural changes in the home. Licensee provided an updated sketch and the living room was approved for day care use

Licensee would like to make the Kitchen and Living Room #2 (adjacent to Kitchen) off limits as of today. LPA approved the spaces and marked as off limits.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LOTFY REZVANI, MANA
FACILITY NUMBER: 073409455
VISIT DATE: 04/04/2024
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On limits Indoor


Level 1: Bedroom #1 (infant nap room), Living room #1, Bathroom, Hallway, Family room.
Off limit areas : Level 1: Living room #2, Kitchen, Garage, Bathroom in garage, Laundry Area. Level 2: Entire Floor

On limit Outdoor: Backyard
Off limit Outdoor : Side yard

Licensee's CPR First Aid certification expires 12/2024 and Mandated Reporter training valid until 1/21/25. Children files were reviewed and complete.

Licensee was reminded that an assistant is needed with a large family childcare home license and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family childcare home. Parent Notification LIC 9150


must be provided to parents when caring for more than 12 children.
Change of capacity application will be approved after submission of Plan of Correction.

Exit interview conducted and report was reviewed with the licensee Mana Lotfy Rezvani . A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
LIC809 (FAS) - (06/04)
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