<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403754
Report Date: 05/16/2023
Date Signed: 05/16/2023 11:00:53 AM

Document Has Been Signed on 05/16/2023 11:00 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HAGHIGHI, FERESTEH & KHAKPOUR, KHOSROWFACILITY NUMBER:
434403754
ADMINISTRATOR:FERESTEH & KHOSROWFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 269-9815
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Feresteh & KhoshrowTIME COMPLETED:
11:15 AM
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) Kassandra Medrano conducted an annual required inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee today. Present in the home are 12 children, both licensees, Feresteh and Khoshrow, and 1 helper, Layla Haghighi. Capacity and ratio requirements of children were observed in compliance today. This type of home is a single story, single family home. OFF LIMIT AREAS: Garage and Both sides of the yard. Adults living in the home are both the licensees. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. The day-care operates 7:30am-5:30pm, Monday-Friday. Licensee has day-care insurance through: Markel. LPA observed the following: Day-care area is clean, orderly, and equipped with age-appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during
day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke
and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no
bodies of water on the property. There is in the day-care area. There are no detergents, or cleaning products
accessible to day-care children. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee’s CPR and First Aid expires 5/2024. Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and meals Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up to date.
Children and staff/helper files were reviewed and are complete. Supervision and transportation of children
was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for
more than the capacity as stated on the license. Requirements for reporting suspected child abuse was
discussed, as well as reporting requirements for unusual incidences. During inspection, Licensee Khoshrow had to leave for an appointment so he was unable to sign report.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HAGHIGHI, FERESTEH & KHAKPOUR, KHOSROW
FACILITY NUMBER: 434403754
VISIT DATE: 05/16/2023
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
26
27
28
29
30
31
32
All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist)
Licensee has updated immunizations. Licensee was reminded that as of September 1, 2016, a person may
not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza,
pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and
1597.662. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. Licensee
was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or
www.mandatedreporterca.com). 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. This report and appeal rights were discussed with Licensee. This report must be available in the
facility for public review. 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/inspection-process.

Notice of Site Visit was given and must remain posted for 30 days. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.

Exit interview conducted and report was reviewed with the licensee, Feresteh.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3