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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625436
Report Date: 01/24/2024
Date Signed: 01/24/2024 10:41:13 AM

Document Has Been Signed on 01/24/2024 10:41 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:KOHZAD, MAHNAZFACILITY NUMBER:
343625436
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/24/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mahnaz KohzadTIME COMPLETED:
11:00 AM
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On January 24, 2024, Licensing Program Analyst (LPA), met with licensee, Mahnaz Kohzad for the purpose of a capacity increase. Licensee was previously licensed as a large family childcare, before their relocation. Licensee, opted to relocate and open as a small family childcare initially, and request a capacity increase after settling in.

Upon arrival LPA observed five (5) children in care with the licensee, spouse and an assistant present.
LPA toured the facility and observed the changes made that were requested by the Fire Marshal, which included a wall mounted pull fire alarm and new door locks. LPA observed a fully charged fire extinguisher of the correct size and a current CPR certificate with an expiration of March 2025.

Effective today, January 24, 2024, 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.

An exit interview was conducted and a notice of site visit was provided.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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