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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624033
Report Date: 11/15/2022
Date Signed: 11/16/2022 08:15:51 AM

Document Has Been Signed on 11/16/2022 08:15 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:NAZARI, NASEMEHFACILITY NUMBER:
343624033
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/15/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nasemeh NazariTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Gagandeep Singh and Corina Beckby for a case management inspection. The licensee has applied for a large family child care home license. The department has requested the local fire department to inspect the home for new capacity. Per licensee, the house was inspected and clearance was granted.

During today's inspection, LPAs inspected the home for health and safety hazard. LPAs inspection the Kitchen, Dining area, Family room, Hallway, Bathroom in hallway, two bedrooms in the hallway and the Backyard. During inspection, LPAs observed licensee has fully charged fire extinguisher, smoke alarm in each room and carbon monoxide detector in the house. LPAs observed the house is in good repair. LPAs observed licensee has license and all of the other required documents posted next to the main entrance and are visible for public. Licensee has CPR training certificate valid until January 2023. During today's inspection, LPAs provided a handout of new capacity and ratio.

During today's inspection, LPAs did not observe any hazard in the house. The department has not received the approved fire inspection clearance from local fire inspection. Upon receiving the clearance, the license with new capacity will be granted.

Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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