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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625049
Report Date: 08/11/2023
Date Signed: 08/11/2023 11:23:17 AM

Document Has Been Signed on 08/11/2023 11:23 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NOORISTANI, MASOUDAFACILITY NUMBER:
343625049
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/11/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Masouda NooristaniTIME COMPLETED:
11:30 AM
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At 11:00 a.m. on Friday, August 11th, 2023, Licensing Program Analysts (LPAs) Karyn Guerra and Kyrsten Williams met with Licensee, Masouda Nooristani, for the purpose of a Case Management - Licensee Initiated inspection. Licensee requests a capacity increase from 8 to 14 children. A fire clearance has been received and is on file with the department. No children were present during today's inspection. All individuals subject to a background review have obtained a criminal record clearance.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include son's bedroom, master bedroom/bathroom, and garage. LPA discussed ratios for a large capacity, and documents required for staff or adult assistants.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. This facility evaluation report was reviewed and discussed with the licensee, Masouda Nooristani. A Notice of Site Visit was provided and shall remain posted for 30 days for parental review.

Effective today, 8/11/2023, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years. Licensee understands that when there is no assistant present, the facility reverts back to the ratios of a small capacity.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2023
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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