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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626424
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:42:13 PM

Document Has Been Signed on 03/06/2025 01:42 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:JALALI, MASOUME & BASHIRFACILITY NUMBER:
343626424
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
03/06/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Masoume & Bashir JalaliTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 03/06/2025 at approximately 12:15 PM, Licensing Program Analysts (LPA) Loraine Perez met with Applicant, Masoume & Bashir Jalali, for the purpose of an announced pre-licensing inspection. Present during today’s visit were the Applicants and one minor son who does count toward capacity. All individuals subject to criminal background review have obtained a criminal record clearance.

The home is a two story house which includes three bedrooms and three bathrooms, a kitchen with dining area, two living rooms, laundry room, garage, and fully fenced backyard with an in ground pool. Off-limits areas include: entire second floor, laundry room, garage, backyard. Applicants understands children may never enter off-limit areas.

A health and safety inspection was conducted on the interior and exterior of the home. Toxic and hazardous items, sharp knives, and medications are inaccessible to children. LPA observed a functioning combination smoke and carbon monoxide detector within the home. LPA observed a fireplace is barricaded to meet regulation. Applicants stated that there are no poisons at the home. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. Applicants stated there are no weapons at the home. LPA observed an in ground pool in the backyard.

Report continues on LIC809-C.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: JALALI, MASOUME & BASHIR
FACILITY NUMBER: 343626424
VISIT DATE: 03/06/2025
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Corrections to be made prior to licensure:
  1. Barricade for stairs that lead to second floor
  2. Fully changed 2A10BC Fire extinguisher
  3. In ground Pool requirements
  • 60 inch height Fencing
  • Self- closing, Self latching gate.
  • Water entering pool alarm or Pool cover
  • Additional safety equipment: life ring and rescue pole with body hook

LPA will return once corrections are made for pre-license inspection.

Pending completion of corrections listed above, this facility will be approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

Exit interview conducted and report was reviewed with the Applicants, Masoume & Bashir Jalali.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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