434404637-1-21-2020-07-CC-SRED-BL2RE8-20200121115706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404637
Report Date: 01/21/2020
Date Signed: 01/21/2020 11:57:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SHEHABI, FARIDOKHT		FACILITY NUMBER:	434404637
ADMINISTRATOR:	FARIDOKHT SHEHABI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 260-2561
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	14	CENSUS: 7	DATE:	01/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Faridokht (Faye) Shehabi		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Shannel Reed met with Faridokht “Faye” Shehabi, Licensee, for an unannounced annual/random inspection. LPA also observed Licensee's Assistants, Hengameh Sefati and Mahboobeh Firoozmanesh, with one (1) infant and five (5) preschool aged day care children in the home during today's inspection. The adults that reside in the home is only the Licensee. The home has barricaded stairs. Days and hours of operation are Monday - Friday from 8:00 AM to 6:00 PM. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection, the last fire drill is reported as being conducted on 06/21/19. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working telephone in the home. LPA observed sufficient materials in the Play Room, toys, and play equipment for the day care children. The Licensee has also converted the garage into a storage and supplies room, mostly used by Helpers to store refrigerated food and change diapers. There was a fish aquarium filled with water and live fish in the garage /converted storage room. The home is clean, orderly, and safe for the day care children. LPA a barricaded fire place inside the home. Off limit areas inside Licensee's home: kitchen, the entire upstairs (bedrooms and bathrooms. Off limit areas outside the home: back yard. The children utilize the front courtyard and outer area with supervision at all times. LPA review the Licensee’s and three (3) Assistant’s file information. The Licensee's certifications for CPR and First Aid are current and expire 06/06/21. The Licensee’s Assistant’s also have current CPR/ First Aid. LPA observed the required Immunization’s against Measles, Pertussis and/or Influenza opt out statement and the Mandated Reporter Training Certificate on file for the Licensee and her applicable staff. LPA reviewed the eight (8) enrolled children’s files. All files have the required documentation and immunization's. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 01/21/20):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SHEHABI, FARIDOKHT	FACILITY NUMBER: 434404637
	VISIT DATE: 01/21/2020

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 01/21/20):
LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee’s states that they do not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.

A Type B Title 22 deficiency was cited during today’s inspection.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SHEHABI, FARIDOKHT	FACILITY NUMBER: 434404637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2020 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. ---- This requirement is not met as evidenced by: Licensee stated, and her log reflects that the last Fire Drill was conducted on 06/21/19.
	8 9 10 11 12 13 14	The Licensee understands that this poses a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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