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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313998
Report Date: 03/16/2022
Date Signed: 03/16/2022 10:22:33 AM

Document Has Been Signed on 03/16/2022 10:22 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SOBHANI, MINOOFACILITY NUMBER:
304313998
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/16/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Applicant Ms. Sobhani, Minoo TIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an announced Pre-Licensing inspection at the new home. It is a Relocation for a Small Family Child care home.
LPA met with the Applicant Ms. Sobhani, Minoo at the new home. However at this time of inspection, the applicant is not ready and the home still needs to be set up meeting the regulatory requirements.

LPA shall conduct the inspection at the later time, when the home is ready and the Day care requirements are set up by the applicant, for indoor and outdoor activities.

Exit interview completed.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022
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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