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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300560
Report Date: 10/23/2023
Date Signed: 10/23/2023 01:05:00 PM

Document Has Been Signed on 10/23/2023 01:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:FOOLADI/RAHIMI FAMILY CHILD CAREFACILITY NUMBER:
336300560
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Fahimeh FooladiTIME COMPLETED:
02:00 PM
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On October 23, 2023, at 1:31PM, Licensing Program Analyst (LPA) William Chancellor conducted a case management inspection for an increase of capacity, requested by licensees Fahimeh Fooladi and Masoud Rahimi.

The licensees have applied to increase the capacity from a Small to a Large Family Child Care Home. A fire clearance was granted for an increase of capacity on 10/13/2023.

LPA reviewed assistance file and confirmed all necessary documents were provided including:
  • Verification of control of property is on file
  • Immunization's including TB clearance
  • Mandated Reporter Training expires on 7/1/24 for both Fahimeh Fooladi and Masoud Rahimi.
  • Pediatric CPR and First Aid Card expires on 6/2025 for Fahimeh Fooladi and Masoud Rahimi.
  • Health & Safety Certificate - completed on 09/13/2020-Masoud Rahimi, Lead 08/18/2020 and 05/19/202-Fahimeh Fooladi, Lead 08/18/2020.


The application for a a capacity increase to become a Large Family Child Care Home will be submitted for approval with a maximum capacity of 14 with parent notification.

Exit interview conducted and report was reviewed with the Fahimeh Fooladi, licensee.
A notice of site visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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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