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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004683
Report Date: 08/17/2022
Date Signed: 08/17/2022 04:08:12 PM

Document Has Been Signed on 08/17/2022 04:08 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:JALALI, MOZHGANFACILITY NUMBER:
414004683
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
08/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee, Mozhgan JalaliTIME COMPLETED:
04:15 PM
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On August 17th, 2022, Licensing Program Analyst's (LPA) Tapia-Mandujano conducted an unannounced inspection for increase of capacity today and met with licensee, Mozhgan Jalali for her request to increase from a Small to a Large Family Child Care. Fire Clearance was received by Redwood City Fire Department. Present in the home is licensee caring for three children (2 infants and 1 preschooler).

Licensee owns home, which is a 2 bedroom, 2 bathroom, single level house. The hours of operation are Monday-Friday from 8am-5pm. Daycare area is: Living Room, Bedroom #1 & 2, Bathroom #1, and Backyard. OFF limit areas: Front swweyard, Kitchen (pass through only to backyard), and Bathroom #2. All off limit areas, including all closets, are properly barricaded.

LPA observed home to be clean and in good repair with proper temperature and ventilation. There is a variety of age appropriate toys and equipment in the home which are in good condition. There are no pools, spas, or bodies of water on the property. Home has a fireplace that is properly barricaded. Backyard is fenced and properly barricaded. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a fully charged fire extinguisher, and a working telephone. Per Licensee, there are no weapons or firearms in the home. Per licensee, there are no pets in the home. Licensee's CPR & First Aid expires on 04/2024. Licensee's Mandated Reporter certificate expires on 08/2024. Postings were posted near main door. Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Capacity limits of a Small and Large Family Child Care Home were explained.

LPA will reccommend for approval of a Large Family Child Care Home License as of today, August 17th, 2022.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed by licensee, Mozhgan Jalali.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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