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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400694
Report Date: 08/16/2024
Date Signed: 08/20/2024 08:10:05 AM

Document Has Been Signed on 08/20/2024 08:10 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SHADRAVAN FAMILY CHILD CAREFACILITY NUMBER:
198400694
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
08/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Licensee - Sara ShadravanTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned address on 08/16/24. LPA arrived at the facility at 12:30 PM and was met by licensee, Sara Shadravan, who guided analyst on a tour of the facility. LPA observed 5 napping children in the home. No additional adults were observed in the home.

The purpose of this visit is to inspect the garage so it can be used as an activity space for children in care. Per licensee, children will exit the home through the door located in the kitchen, walk through the backyard area and into the garage. LPA observed the garage space to have child sized table, child sized chairs, a fully functional kitchen, a refrigerator, a laundry area and a bathroom. A wall mounted air conditioning unit was observed in the garage space. Per licensee, the backyard space is currently off limits to children in care due to the recent construction to the garage space. Per licensee, items to be used in the garage space are temporarily stored in the backyard. Licensee states that she plans to clear up the backyard area and make it accessible for children by the end of the weekend (08/18/24). Per licensee, she does not have an additional dwelling unit certificate for the garage space.

LPA advised licensee that garage space can only be used as an activity space for children in care. Children will not be allowed to take naps or meals in the garage space once it has been made accessible.

Prior to garage being used as an activity space, licensee must complete the following:
-backyard area must be made accessible to children in care
-Children items taken out of the activity space must be placed back and made accessible to children in care

Notice of site visit was given and must remain posted for 30 days

Exit interview conducted and report reviewed with licensee, Sara Shadravan.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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