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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409485
Report Date: 03/15/2024
Date Signed: 03/15/2024 09:45:33 AM

Document Has Been Signed on 03/15/2024 09:45 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: 5CENSUS: 5DATE:
03/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Golpar & Ali NosratiTIME COMPLETED:
10:30 AM
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On 3/15/24 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection at Golpar Nosrati's family childcare home. LPA met with Licensee, Golpar and her spouse, Ali. Present in the home were 5 children (3 infants, 2 preschoolers). Facility is in ratio compliance today.

Purpose of today's inspection is to follow up on Case Management inspection conducted on 3/7/24. LPA inspected newly installed window fences on 3 windows that open out into the swimming pool area in the backyard. First window is located in the (off limit) Master Bedroom, second window in the Master Bathroom (off limit); and third window in the son's bedroom (also off limit). LPA walked through the indoor and outdoor areas, inspected installations, outdoor fencing of the pool, and took pictures of the window installations for documentation purposes.

No deficiency was cited today. Approval of pending increase capacity application is subject to management review. This report was reviewed and exit interview conducted with Licensee, Golpar Nosrati and spouse, Ali Sabzevari.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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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