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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409485
Report Date: 03/07/2024
Date Signed: 03/07/2024 01:57:54 PM

Document Has Been Signed on 03/07/2024 01:57 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:NOSRATI, GOLPARFACILITY NUMBER:
073409485
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
03/07/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Golpar Nosrati and Ali SabzevariTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Cherie Acosta and Dealia Frison conducted an unannounced Case Management inspection. Licensee requested an increase in capacity to care for 14 children. Licensee has obtained a signed Property Owner/Landlord Consent form (LIC9149). Licensee has the required one year experience. Licensee was previously licensed under facility number 073408966. Licensee has an approved fire clearance dated 2/21/24. Present during today’s inspection was the licensee, her fingerprint cleared husband, 2 preschool aged children and 2 infants in care.

The home was toured for Health and Safety Inspection. During the inspection licensee request bedroom # 4 to be added on limits. The approved on limits area as of today include the living room, half bathroom, bedroom #1, bedroom #4 and the backyard. The remainder of the home is off limits to children in care. Off limits areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. The home has a fireplace located in the off limits are of the home.. LPA verified that the fire extinguisher 2A10BC is fully charged. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced.
The home has a pool and hot tub. There is a 5 foot fence with a self latching gate separating the pool/ hot tub area from the outdoor play area. The home has windows located on the side of the house where the pool is located , this area is not fenced.

The licensee is operating within the licensed capacity. LPA did not observe any child left without supervision during the inspection.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: NOSRATI, GOLPAR
FACILITY NUMBER: 073409485
VISIT DATE: 03/07/2024
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The increase in capacity is pending manager approval.

Notice of Site Visit was provided and must be posted for 30 days.

Report was reviewed with Golpar Nosrati and Ali Sabzevari
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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