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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628149
Report Date: 06/10/2024
Date Signed: 06/10/2024 01:59:56 PM

Document Has Been Signed on 06/10/2024 01:59 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 DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RANJBAR, SHAHLA FAMILY CHILD CAREFACILITY NUMBER:
376628149
ADMINISTRATOR/
DIRECTOR:		SHAHLA RANJBARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 295-5230
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Shahla RanjbarTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On June 10, 2024, Licensing Program Analyst (LPA), Sherlynn Banas, conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Abdolhousa Shegarfi (husband of licensee) and granted entry after identifying herself and disclosing the purpose of her visit. Abdolhousa Shegarfi brought LPA Banas to Licensee, Shahla Ranjbar. At this time, facility is not operating due to health reasons.

Licensee, Shahla Ranjbar requested to be inactive from June 1, 2024 to August 31, 2024. LPA provided the form for Inactive Status Request for which the licensee signed it. Shahla has requested information regarding update of her license. LPA provided information and forms to be submitted regarding the update.

Exit interview conducted and report was reviewed with the licensee, Shahla Ranjbar.



SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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