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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100913
Report Date: 03/08/2022
Date Signed: 03/08/2022 05:46:13 PM

Document Has Been Signed on 03/08/2022 05:46 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GHOLAMI, ZAHRA FAMILY CHILD CAREFACILITY NUMBER:
376100913
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/08/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Zahra GholamiTIME COMPLETED:
05:14 PM
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On 3/2/22 @ 3:00pm, Licensing Program Manager (LPM) Renesha Pack and Licensing Program Analyst (LPA) Patrick Ma conducted a meeting with Zahra Gholami via MS Teams due to COVID-19 restrictions. The purpose of this meeting is to discuss her citation history and to clarify department expectations.

Ms. Gholami has been licensed previously and received several Type A citations which are an immediate health & safety risk to children in care. The following Type A deficiencies were cited at facility #376100365:

On 01/31/22 A Complaint was received alleging the facility was over licensed capacity. On 2/3/22 the complaint was Substantiated and the Ms. Gholami was issued a citation under 102416.5 Staffing Ratio & Capacity due to Ms. Gholami being over capacity 17 days in May with 10 children, 12 days in September with 11 children. Ms. Gholami was licensed for only up to 8 children.

On 09/14/2021 A complaint was received alleging the Licensee did not live in the home. On 01/13/21 the Complaint was Substantiated and Ms. Gholami was issued a citation under 102417(a) Operation of a Family Child Care Home due to Ms. Gholami not living in the daycare home as required.

A Case Management Deficiencies visit was also conducted on 01/13/2021 and Ms. Gholami was issued a citation under 102416(d)(1) Personnel Requirements for failing to have 6 residents who lived in the home background cleared or associated to the facility as required. A civil Penalty was issued in the amount of $3000.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GHOLAMI, ZAHRA FAMILY CHILD CARE
FACILITY NUMBER: 376100913
VISIT DATE: 03/08/2022
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The following Type A deficiencies were cited at facility #376628104:

On 7/18/19, RO received a complaint alleging that the Licensee does not live in the home. Although the allegation was Unsubstantiated it causes concern for the department since the same allegation was alleged and substantiated under the following license.

On 9/9/19, facility was cited under 102417(g)(10) Operation of a Family Child Care Home due to hazardous cleaning materials being accessible to children under the kitchen sink.

It should be noted that the facility was also cited several Type B deficiencies under facility# 376628104 above which included: Assistants caring for children alone without proper CPR/First Aide certifications, Cigarettes and paraphernalia on living room side table accessible to children and having prohibited items in the home (baby walker).

A copy of each of the following Regulations were reviewed with and a provided to Ms. Gholami: 102417 Operation of a Family Care home, 102416.5 Staffing Ratio and Capacity, and 102416 Personnel Requirements. LPA also provided Licensee with the General Health & Safety Information handout and a Small FCCH Ratio handout.

Ms. Gholami was also provided with the Compliance and Regulatory Enforcement (CARE) Tools website: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/inspection-process-project/care-tools to review the Child Care Standard tool used by LPAs when conducting inspections in licensed facilities & CDSS Child Care Licensing (CCL) Family Child Care Providers Resource link with instructional videos: https://ccld.childcarevideos.org/family-child-care-providers/. It is recommended for Ms. Gholami to review the videos including, but not limited to: What is a Civil Penalty, Background Check Requirements for Caregivers, How Many Children Can Attend a Family Child Care Home, and Supervising Children in Family Child Care. Licensee was also provided with information on Smart Horizon courses, which are available on the following link to assist with training needs: https://www.smarthorizons.org/childcare. Licensee is aware that training should be provided to any individual who works in the childcare as well.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GHOLAMI, ZAHRA FAMILY CHILD CARE
FACILITY NUMBER: 376100913
VISIT DATE: 03/08/2022
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Ms. Gholami was advised to regularly visit the Community Care Licensing WEB SITE: www.ccld.ca.gov for quarterly updates and regulations. Ms. Gholami stated she is signed up to receive the PIN's. During meeting Ms. Gholami was provided the Duty Line: 619-767-2248.

Ms. Gholami has submitted a request which is pending approval for a Civil Penalty payment plan currently the invoice has not been processed and received. The Department plans to approve this payment plan of $250 to be paid each month until paid in full. Ms. Gholami has submitted her initial payment of $250 shall receive a future notice of this approval which will break down the payment agreement. Ms Gholami was advised that her payments are due by the 15th of each month once the invoice is received and payment plan approved. Failure to make payments as promised will void the payment plan and the final balance will be due in full.

Ms. Gholami was advised that the above violations are serious and if repeated could be grounds for administrative action against the license. Ms. Gholami agrees to operate the facility in full compliance with Title 22 and Health & Safety Code requirements. The Department has approved and will issue Ms. Gholami a license effective 3/8/22.

Ms. Gholami was emailed a copy of this report and above discussed documents. Ms. Gholami’s reply to the email is considered confirmation of receipt. Ms. Gholami is to print, sign and return a copy of this report once received.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
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