Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627064
Report Date: 09/13/2018
Date Signed: 09/13/2018 10:24:56 AM

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:GHOLAMI, GHOLAM & HOSEINI, MARYAM FCCFACILITY NUMBER:
376627064
ADMINISTRATOR:MARYAM H,& GHOLAMI GHOLAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 792-8995
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:14CENSUS: 0DATE:
09/13/2018
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maryam HoseiniTIME COMPLETED:
10:30 AM
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Licensing Program Manager (LPM) Tulam Vu and Licensing Program Analysts (LPAs) Vicky Williamson and Marea Behvand conducted an office meeting with Licensee Maryam Hoseini at the San Diego Child Care Regional Office. Licensee's daughter Zahra Gholami aided as a translator due to Licensee's primary language being Farsi. The purpose of today's meeting is to discuss previously cited deficiencies, ratio/capacity, children's records and review of regulations.
Staffing/Ratio and Capacity Regulation 102416(a) – A “Type A” deficiency was cited on 7/26/18, where the facility was operating over capacity on April 11, 12, 18, 19, 25, and 26 between the hours of 5:30PM and 6:39 PM, licensee exceeded license capacity by providing care for a total of 12 children at one time. On the same above dates, between the hours of 6:40PM and 9:35PM, licensee exceeded capacity by providing care for a total of 11 children at one time. During that time the license was granted for only 8 children. Licensee acknowledged that on the above dates they were operating over capacity. Licensee stated that she understands the regulations discussed during this meeting and agreed to operate the Family Child Care Home according to the conditions, limitations, and capacity specified on the license at all times. Licensee also agreed to comply with all licensing laws and regulations.

The following resources were provided to Licensee during today's meeting: the CCL Division Quarterly Updates, visuals for ratio/capacity, LIC 311D Form/Records to Keep In Keep In Your Family Child Care Home, California Car Seat Law Changes, Disaster Planning Self-Assessment Guide, SIDS and Shaken Baby Syndrome pamphlets, and the Family Child Care Self-Assessment Guide. Reporting Requirements were also discussed. The CCLD website www.ccld.ca.gov which has information regarding forms, regulations, online training, new laws and PINS were discussed.

For additional questions the licensee can contact LPA Vicky Williamson at (619) 767-2214 or the Duty Line Monday - Friday 8am - 5pm at (619) 767-2248 or CCIB at (844) 538-8766. This report was explained and translated in Farsi by Zahra Gholami.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2018
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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