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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202816
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:30:21 PM

Document Has Been Signed on 09/15/2022 03:30 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
CENTRAL COAST CR/RES, 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:
09/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Sarah ShamiraniTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection to focus on infection control and met with the Licensee's wife, Sarah Shamirani. Licensee, Iman Tootoonchi was called but was unavailable to meet LPA at the facility.

No clients are currently living at the facility.

During visit, LPA toured the facility to include the living room, dining room, kitchen, bedrooms, bathroom, garage, and backyard. The following posters observed to include required mask, social distancing, symptoms of COVID, and hand washing.

Licensee is expecting to start admitting clients in October 2022. The licensee will ensure to provide a COVID screening area for symptoms screening and temperature check for all visitors, clients, and staff, have a sufficient 30-day supply of PPE, and have an infection control plan and procedures in place prior to admitting clients. Licensee will submit the facility's infection control plan to the Department, ASAP.

No deficiencies were cites per California Code of Regulations, Title 22.

This report was reviewed with Iman Tootoonchi on the phone, and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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