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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415598
Report Date: 10/11/2021
Date Signed: 10/11/2021 04:06:27 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:NEINAVAEI, SHIMAFACILITY NUMBER:
434415598
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
10/11/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Shima NeinavaeiTIME COMPLETED:
04:20 PM
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Licensing Program Analysts (LPAs) Ofelia Calivo and Mel Matos met with Shima Neinavaei, Licensee, to conduct an unannounced Case Management Inspection. Purpose of today's inspection: address the application submitted by Shima Neinavaei, Licensee, requesting an increase in licensed capacity from 8 to 14 children. LPAs also observed Licensee’s husband, Hamidreza Khosravi, and Licensee's minor daughter in the home during today's inspection. There were no day care children present since the day care was closed for the Columbus Day holiday.

The Licensee has been licensed as a small Family Child Care Home License since March 9, 2020 and thus has met the minimum one year experience requirement. The Licensing Department received a granted Fire Clearance for a capacity of 14 children. LPAs toured the indoor and outdoor areas of the home with the Licensee during today's inspection. Areas to be used by children: Living room, bedrooms 1 and 2, hallway bathroom and the kitchen. Areas off-limits to children: Attached garage and Master bedroom. There are no stairs, fireplace, or wall heater units inside the home. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children.

The Licensee's CPR/First Aid certifications expired on 11/18/2020 and proof of enrollment for certification renewal (scheduled for 10/16/2021) was emailed to LPA Calivo. The Mandated Reporter Training for Child Care Workers expired on 10/03/2021 and the Licensee states that she is in process of renewing that certification as well.

There were no deficiencies cited during today's inspection.

LPA conducted an exit interview with the Shima Neinavaei, Licensee, prior to the conclusion of today's inspection and advised her that a Large Family Child Care Home license will be approved upon completion/submission of the following:

*Renewed First Aid & CPR certification.
*Renewed Mandated Reporter Training certification.
*Review & approval completed by LPAs supervisor.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia CalivoTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
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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