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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418802
Report Date: 03/15/2023
Date Signed: 03/15/2023 09:53:40 AM

Document Has Been Signed on 03/15/2023 09:53 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ZABOLI FAMILY CHILD CAREFACILITY NUMBER:
197418802
ADMINISTRATOR:ZABOLI, ROYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 308-4624
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Shaba ShahriariTIME COMPLETED:
10:00 AM
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On 03/15/2023 Licensing Program Analyst (LPA) Deborah Lowe arrived at facility to conduct a case management visit. LPA Lowe met with Shaba Shahriari.

Shaba advised LPA Lowe the licensee Roya Zaboli was not home. LPA advised the purpose of the visit. Per Shaba the daycare is closed.

LPA Lowe verified Shaba Shahriari has a background clearance and is associated to facility. LPA toured the daycare room. LPA Lowe verified no children were present in the daycare room or daycare bathroom.

Area was observed to be empty with only a bed. No evidence of child care occurring.


LPA Lowe reviewed and provided a copy of this report with Shaba Shahriari.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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