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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202816
Report Date: 08/30/2021
Date Signed: 08/31/2021 08:36:55 AM

Document Has Been Signed on 08/31/2021 08:36 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SHIRAN CARE MANAGEMENT INC.FACILITY NUMBER:
435202816
ADMINISTRATOR:JONES, NATALIE YVETTEFACILITY TYPE:
735
ADDRESS:545 BISCAYNE CTTELEPHONE:
(408) 649-8537
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 6CENSUS: 0DATE:
08/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Iman Tootoonchi, LicenseeTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Steve Chang conducted an announced pre-licensing inspection, and met with licensee Iman Tootoonchi (IT).

Facility had applied for 6 capacity including one non-ambulatory room of two residents and 3 ambulatory rooms with 4 residents. During the inspection, LPA inspected and observed 2 resident single rooms, 1 shared restroom, and 2 resident shared rooms each with restroom inside. All the rooms and restrooms are all on the first floor. LPA toured the living room, dining room, kitchen, and garage. The medication cabinet was observed locked. The storage of knives, sharp objects and toxic cleaning products were observed locked. The two staff live-in bedrooms and one restroom on the second floor were inspected. All the linen closets and cloth closets were inspected.

The smoke detectors were inspected. All smoke detector were working fine. Fire extinguisher date is valid. Address Identification was placed and was clearly visible.

Front yard and back yard were inspected, and were observed free of obstruction. No bodies of water were observed in the backyard. The fence and gate were in good condition. The gate in the backyard was not locked. There were string attached to latch of the gate to be able to open the gate from outside of the gate for non-ambulatory access.

Component III orientation was conducted for IT. LPA answered the questions that IT asked. Exit interview was conducted. No deficiency was noted during today's inspection. This report was provided to IT to review and to sign. A copy of this report emailed to IT.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2021
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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