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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625049
Report Date: 07/11/2024
Date Signed: 07/11/2024 02:04:49 PM

Document Has Been Signed on 07/11/2024 02:04 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NOORISTANI, MASOUDAFACILITY NUMBER:
343625049
ADMINISTRATOR/
DIRECTOR:		NOORISTANI, MASOUDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(214) 259-6009
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
07/11/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Masouda NooristaniTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Kyrsten Williams met with Licensee, Masouda Nooristani, for the purpose of an unannounced plan of correction inspection. Census included five children being supervised by licensee and assistant. All individuals subject to criminal background review have obtained a criminal record clearance.

LPA observed all adults in the home have obtained a criminal record clearance. LPA will clear deficiency HSC 1596.871(c)(1)(A) that was cited on 07/03/2024.

Report was reviewed with Licensee, Masouda Nooristani and exit interview was conducted. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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