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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845544
Report Date: 10/09/2024
Date Signed: 10/09/2024 10:23:43 AM

Document Has Been Signed on 10/09/2024 10:23 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:GHOLIPOOR FAMILY CHILD CAREFACILITY NUMBER:
334845544
ADMINISTRATOR/
DIRECTOR:		GHOLIPOOR,MEHRNAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 506-1915
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Mehrnaz GholipoorTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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On October 9, 2024, at 8:55 AM, Licensing Program Analyst (LPA) Anastasia Flores, Licensing Program Manager (LPM) Pauline Beschorner arrived for the purpose of overturning a deficiency that was issued on 04/04/24. Our agency has overturned the allegation of an uncleared adult (A1) being in the day care home while children are in care.

A copy of this report, appeal rights, and (LIC811) Confidential names list, was handed to Licensee Mehrnaz Gholipoor.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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