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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409485
Report Date: 11/16/2023
Date Signed: 11/16/2023 11:39:08 AM

Document Has Been Signed on 11/16/2023 11:39 AM - 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:NOSRATI, GOLPARFACILITY NUMBER:
073409485
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Golpar Nosrati and Ali SabzevariTIME COMPLETED:
11:45 AM
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On November 16, 2023 at 9:20am, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an announced Change of Location inspection. LPA met with applicant Golpar Nosrati and her husband Ali Sabzevari. Living in the home are the Licensee, her husband, and adult son. The Licensee plans to operate Monday-Friday 8am-5pm. LPA verified the Licensee's phone number and email on record are correct.
LPA toured the home for a health and safety check. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children.

The home is a single story house, which consists of a living room, kitchen, dining room, family room, a laundry room, office, three bedrooms, two and half bathrooms, a two car garage, fully fenced in front and backyard and a fully fenced in-ground swimming pool.

The Off Limit Areas are the all three bedrooms, the two full bathrooms, family room, dining room, laundry room, garage, swimming pool, and kitchen. The off limits areas will be made inaccessible by gate, closed and/or locked doors and visual supervision.

The On Limit Areas are the living room, half bathroom, backyard, and the office which will be used as the Isolation area. The backyard is fully fenced in and will be used for outdoor play.

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, bodies of water, hazardous items or poisons accessible to children during the inspection today. The applicant stated there are no firearms in the home.

The home is equipped with a fully charged 3A40BC fire extinguisher, working combined smoke and carbon monoxide detector, and a working telephone. The Licensee has a current CPR and First Aid certificate and a current Mandated Reporter Certificate expiring on October 17, 2024. The applicant does not have Liability insurance for the daycare and was reminded to have parents sign the "Affidavit


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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: NOSRATI, GOLPAR
FACILITY NUMBER: 073409485
VISIT DATE: 11/16/2023
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. A copy of the Infant Safe Sleep regulations were provided.

On November 16, 2023 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The License will be granted and is active as of today November 16, 2023.


Exit interview conducted and report was reviewed with Licensee Golpar Nosrati.

*******************************************************End of Report**********************************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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