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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101451
Report Date: 03/20/2023
Date Signed: 03/20/2023 08:21:23 AM

Document Has Been Signed on 03/20/2023 08:21 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SHAHSAVARIAN, NAZANIN FAMILY CHILD CAREFACILITY NUMBER:
376101451
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Nazanin ShahsavarianTIME COMPLETED:
08:30 AM
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On 3/20/23 at 8:00am Licensing Program Analyst Annette Sutherland conducted an  announced follow-up pre licensing inspection. The purpose of this inspection is to observe corrections as requested during a pre-licensing inspection on 3/8/23 .  LPA met with applicant, Nazanin Shahsavarian. The following corrections were observed today:

LPA was able to tour the entire home including all off limit areas. 
Ms. Shahsavarian's furniture has been delivered and is now living in a furnished home.
Ms. Shahsavarian stated that her hours of operation are Monday- Friday 6:30am - 6:00pm

No corrections are needed. A license for 8 children may be issued upon final file review.
The maximum capacity for a small family child care home:  4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.

Licensee was reminded that annual fees are due on the date they were licensed every year.
An exit interview was conducted with applicant. Appeal Rights (LIC9058) were given along with the report (LIC809) to the Licensee.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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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