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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414254
Report Date: 09/27/2022
Date Signed: 10/05/2022 03:47:58 PM


Document Has Been Signed on 10/05/2022 03:47 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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:SABAHI, SEYEDFACILITY NUMBER:
434414254
ADMINISTRATOR:SABAHI, SEYEDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
4086493028
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:14CENSUS: 0DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Sabahi Seyed TIME COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stephanie Collins conducted an unannounced Annual Inspection of the Family Child Care Home. LPA met with Licensee Seyed Sabahi and explained the purpose of today’s inspection.

Licensee resides in the home with his mother (Khadijeh Khanom Saeedi) There were no children present during inspection. Licensee states the Family Home Day Care has not been active in the last two years primarily due to the COVID-19 Pandemic.

The home’s operating days and hours are Monday through Friday 7:00 AM to 6:00 PM. The facility maintains telephone service. Facility’s License and Notification of Parents’ Rights, LIC 9148 Earthquake Preparedness, and Facility License were observed to be posted. Documents reviewed during inspection Lice 610A Emergency Disaster Plan, Verification of Disaster and Fire Drill log, and then LIC 9040 Facility Roster.

Licensee understands the capacity options and understands that the home must comply with the ratio and capacity requirements of a small Family Child Care Home whenever there is only one childcare provider present.

The physical plant was inspected. LPA toured the indoor and outdoor areas of the home. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. LPA did not observe flies, other insects, and rodents during today’s inspection. Furniture and equipment, such as tables, chairs, and play pen were age appropriate and in good condition. There were no baby walkers observed. The fireplace was observed to be screened.

The whole second floor is off Limits. There is a gate at the base of the staircase to prevent access by children. Areas used by children are the Living Room, Dining Room, Kitchen, one bedroom, and a restroom on First floor. LPA reminded licensee that the garage is not approved for daycare use per Fire Safety Inspection on 01/02/16. The backyard is fenced and is used for outdoor activity space. There were no bodies of water observed.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SABAHI, SEYED
FACILITY NUMBER: 434414254
VISIT DATE: 09/27/2022
NARRATIVE
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Licensee stated that there were no weapons such as firearms stored on the premise. Disinfectants, cleaning solutions, sharps, and other items that are dangerous to children in care were stored inaccessible, out of reach of children. A Fire extinguisher was observed. Carbon monoxide and smoke detectors were functioning. Log shows that Disaster Drill was last conducted on 03/20/2022.

The Licensee stated that he does transport children at this time. Licensee understands that children cannot be left alone, unattended in parked vehicles at any time, and children needs to be in their appropriate vehicle restraint system during transportation. Licensee has a current and valid driver license.

Facility's roster of children who are provided care was reviewed and a copy was obtained.

Licensees' file was reviewed, which included records of Criminal Record and Child Abuse Index Clearance, TB clearance, Immunization [Pertussis and Measles], and required Training and Pediatric First Aid and CPR certification expires 05/2024.

Licensee Sabahi Seyed was reminded that all adults 18 and over, 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 Child Care Center. 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.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that he currently does not have any children in care who requires IMS service. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.


SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SABAHI, SEYED
FACILITY NUMBER: 434414254
VISIT DATE: 09/27/2022
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LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

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

Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name).

In the areas that were evaluated regulatory violation was observed at the time of the visit. Exit Interview, where this report was discussed with Licensees.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/05/2022 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: SABAHI, SEYED
FACILITY NUMBER: 434414254

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Licensee Seyed Sabami with completed and submit proof of Mandated Reporter Training by POC date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review), the licensee did not comply with the section cited above in which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2022
Plan of Correction
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Licensee with submit proof of registration and submit proof of completions of Preventative Health and Safety Training to the licensing office by POC date

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: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4