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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700039
Report Date: 02/10/2023
Date Signed: 02/13/2023 10:40:06 AM

Document Has Been Signed on 02/13/2023 10:40 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MOJABI FAMILY CHILD CAREFACILITY NUMBER:
195700039
ADMINISTRATOR:ZIA MOJABIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 596-0353
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91602
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/10/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Zia MojabiTIME COMPLETED:
12:00 PM
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On 2/10/2023 Licensing Program Analyst (LPA) V. Wheatley conducted an announced inspection with applicant Zia Mojabi for the purpose of a pre-licensing inspection of 4417 Camellia Avenue, North Hollywood, CA 91602. The purpose of this inspection is for a new license to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes. The applicant is the only individual present today.

Today's inspection is a second prelicensing inspection to verify the correction of an in ground play set is anchored properly. LPA observed the home and play room the same as the first inspection. LPA observed the backyard the same with the exception of the play set is now anchored properly into the ground. LPA did not observe any hazardous inside or outside of the home.

Based on LPA's observance and inspection the applicant will be licensed for a large family child care home capacity 14. LPA's manager Licensing Program Manager Maureen Neal reviewed the documentation regarding the qualifications for a large license being granted and it has been approved.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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