<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101739
Report Date: 12/05/2023
Date Signed: 12/05/2023 11:38:07 AM

Document Has Been Signed on 12/05/2023 11:38 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:SAMADI, MOHAMMAD FAMILY CHILD CAREFACILITY NUMBER:
376101739
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/05/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Mohammad SamadiTIME COMPLETED:
11:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On December 5, 2023 at 11:05 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an announced follow-up prelicensing inspection. The purpose of this inspection is to ensure that all corrections discussed in LPA Curtis’s prelicensing report dated 11/29/23 have been met. Upon arrival, LPA met with Applicant, Mohammad Samadi and toured the home.

During the 11/29/23 inspection, the applicant advised LPA that he did not live in the home. LPA advised the applicant that he needed to move into the home and live at the residence to be licensed. On 11/30/23 the applicant sent LPA a video and photographs to confirm that he has moved into the home. During today’s inspection LPA observed that there is furniture including beds, a couch, dining table and a T.V. in the home. The closets contain clothing. All cabinets and drawers were reinspected, and LPA found that all poisons, cleaners, and hazardous items in the home are inaccessible to children through latches, locks, and/or placed up on high surfaces. Applicant will use the following areas for child care: living room #1, living room #2/dining area, kitchen, bedroom #1, bedroom #2, bedroom #3, bathroom #1, bathroom #2 and enclosed rear yard. There are no off-limits areas within the home. The applicant will utilize the enclosed rear yard for outdoor activities. The front yard is off-limits. There were no bodies of water observed during time of visit.

***A Regular Small Family Child Care Home License may be granted after final file review. The applicant states that he will comply with all regulations and laws governing family child care homes and that he is financially secure to operate a family child care home for children. LPA reviewed this report with Applicant prior to obtaining his signature, and Appeal Rights (LIC 9058) were provided.



A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1