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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407418
Report Date: 11/04/2021
Date Signed: 11/04/2021 03:30:20 PM

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:KHAZENI, MANIJEH & BEYK, MOHAMMADFACILITY NUMBER:
434407418
ADMINISTRATOR:KHAZENI & BEYKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 736-6310
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 1DATE:
11/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Manijeh Khazeni & Mohammad BeykTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Manijeh Khazeni, Licensee, for unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed one preschool napping child in the home with Mohammad Beyk (co-Licensee/Licensee's spouse) during today's inspection. Licensee was operating within the capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 9:00 AM to 4:00 PM. Licensee, her spouse (co-Licensee), and Licensee's two adult sons (Koosha & Rasa Beyk) are the adults residing in the home. Licensees have current CPR and First Aid certifications (expiration: April 5, 2023).

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on August 5, 2021. Licensee states that she has liability insurance for the day care through DCI and LPA observed a current policy verifying coverage during today's inspection. Licensees have the required vaccines on record (MMR, Tdap, & flu) and both are current with the Mandated Reporter Training for Child Care Workers (expiration: 03/2023). LPA reviewed eight children's files and all files were complete with the required forms. LPA reviewed Licensees file documents and both are complete with the required forms. Licensee states that a child will be isolated in the living room if necessary due to illness or communicable disease.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Drinking water is available via refillable water bottles and filtered water. Licensee states that parents provide all the meals for the children in labeled containers that are properly stored at the day care.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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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: KHAZENI, MANIJEH & BEYK, MOHAMMAD
FACILITY NUMBER: 434407418
VISIT DATE: 11/04/2021
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The home is clean, orderly, and safe for the day care children. Licensees has two barricaded wall heaters inside the home. The main areas of the day care are the back day care room, backyard, and bathroom, located in the back section of the home. Off limit areas in the home: two bedrooms, kitchen, barricaded fireplace (located in the living room), and attached garage. There are no stairs inside the home. Off limit areas outside the home: one locked storage shed. There are no stairs inside the home.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. The Licensee states that there are no poisons in the home. The Licensee states that she does not administer any medication to the day care children at this time.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with at least two qualified adults present. Licensee states that does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.


To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process


Exit interview conducted and report was reviewed with the Licensee, Manijeh Khazeni. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
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