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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004999
Report Date: 12/19/2024
Date Signed: 12/19/2024 03:18:01 PM

Document Has Been Signed on 12/19/2024 03:18 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GHASEMZADEH, MOJGANFACILITY NUMBER:
414004999
ADMINISTRATOR/
DIRECTOR:		GHASEMZADEH, MOJGANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 545-1402
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: DATE:
12/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Mojgan GhasemzadehTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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On December 19, 2024, at approximately 2:30 pm, Licensing Program Analysts (LPAs) Maria Olguin-Leon and Melissa Zaragoza, conducted an unannounced, plan of correction (POC) visit. LPAs met with licensee, Mojgan Ghasemzadeh and explained the purpose of the visit. Present during visit was licensee, helper and 7 children (4 infants and 3 preschool age). Facility is within ratio of staff/children capacity.

On December 13, 2024, LPA Maria Olguin-Leon met with licensee to open a complaint investigation regarding over capacity. During complaint investigation, LPA substantiated licensee was operating over capacity ratio. LPA issued a Type A citation for operating over licensed capacity limits. A POC was developed with licensee. .

As of this date, LPAs Olguin-Leon and Zaragoza confirmed the licensee to have four infants and three preschoolers present. LPAs collected children’s roster. During today’s visit LPAs and Licensee discussed children’s schedules. Per licensee, one infant has moved away and no longer enrolled as of 12/13/2024. LPAs observed licensee to be operating within licensed capacity limits on this date.

During today's visit, LPAs observed signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for the 7 children currently present. LPAs reminded Licensee that all newly enrolled children in the next 12 months must have a LIC 9224 on file. LPAs observed facility site visit and reports posted.

Deficiency cited on December 13, 2024, has been cleared as of this date. LPAs provided licensee copy of POC letter. No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with licensee, Mojgan Ghasemzadeh.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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