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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004999
Report Date: 11/22/2024
Date Signed: 11/22/2024 09:45:58 AM

Document Has Been Signed on 11/22/2024 09:45 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GHASEMZADEH, MOJGANFACILITY NUMBER:
414004999
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
11/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Mojgan GhasemzadehTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On November 22, 2024, at approximately 9:15am, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced, case management visit for an increase of capacity. LPA met with the licensee Mojgan Ghasemzadeh and explained the purpose of the inspection. Present during today’s visit was licensee and 6 children (2 infants & 4 preschoolers). Facility is operating within capacity and child ratios. Hours of operations are Monday – Friday 8:30am to 5:30pm.

Licensees requested to increase capacity from a small family childcare home to a large family childcare home. Capacity increase application was submitted to department October 22, 2024. Fire clearance approval has not been received in Regional Office.

With applicant, LPA inspected the indoors and outdoors of the home for health and safety hazards. Home is a one-level story home; home consist of living room, dining room, kitchen, 3 bedrooms, 2 bathrooms, laundry room, detached garage and backyard. The DAY CARE AREAS: are living room (main playroom), dining room and bathroom #1, bedroom #1 and #2(bedrooms for napping only), kitchen & laundry room/hallway (walk through to backyard), and backyard. The Off-Limits Areas: are bedroom/bathroom #3 and detached garage. Isolation Area for ill children will be in the living room and away from other children. Applicant was notified any off-limit areas are not to be used as a day care area without prior approval from department. Applicant understand applicant will need to keeping napping room doors open while children are napping. LPA observed newly purchased fire alarm system which will be installed in dining room. Bedroom #1 is equipped with plenty of cribs for children to nap, bedroom #2 will be used as needed basis. LPA observed fireplace in living room to be properly barricaded and wall heater is properly barricaded. LPA observed plenty of age-appropriate toys.

Capacity limits and ratios for a large family day care were reviewed with license today. LPA reminded licensees that an assistant must be present when operating as a large license. LPA reminded licensees when an assistant is not present, licensees must operate within capacity limits of a small family childcare home. Licensees were reminded if children live in the home under 10 years old, they are counted towards overall capacity.

Cont. page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GHASEMZADEH, MOJGAN
FACILITY NUMBER: 414004999
VISIT DATE: 11/22/2024
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The licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

LPA will approve increase of capacity for 12 children,pending fire inspection clearance approval.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Mojgan Ghasemzadeh.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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