<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624365
Report Date: 11/21/2022
Date Signed: 11/21/2022 02:49:50 PM

Document Has Been Signed on 11/21/2022 02:49 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MANSORI, KARIMAFACILITY NUMBER:
343624365
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/21/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Karima MansoriTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On November 21, 2022 at approximately 1:55 pm Licensing Program Analyst (LPA) Josiah Gathing met with Licensee, Karima Mansori, for a case management inspection. Licensee applied for a capacity increase from 8 to 14 children in care. Today’s inspection was conducted in order to inspect the house and discuss requirements for a large license. The purpose of the inspection was explained.

During today’s inspection, LPA inspected the day care areas. Daycare areas are: play area, nap area, bathroom 1, kitchen, and fenced back yard. Off-limits areas: All 3 bedrooms, bathroom 2, living room, dining room, and garage. All off limits areas must remain inaccessible to children. Licensee was notified that prior to the use of any off limits area, the department must be notified.

During the inspection, LPA observed the home has multiple smoke alarms and fire extinguishers. There is a carbon monoxide detector and pull alarm. The house was inspected by local fire marshal and the clearance was granted on November 15, 2022. During the inspection LPA informed licensee of the ratio and capacity requirements of large family home license. Licensee stated that she understands the requirements. No violations were observed today.

Copy of this report was reviewed and provided to licensee. This report will be kept in the facility file and will be made available for public review upon request.

Capacity increase is approved as of today, November 21, 2022. The facility is licensed to serve a MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1