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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434404637
Report Date: 03/14/2023
Date Signed: 03/15/2023 03:32:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/16/2022 and conducted by Evaluator Anna Morales
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221216150828
FACILITY NAME:SHEHABI, FARIDOKHTFACILITY NUMBER:
434404637
ADMINISTRATOR:FARIDOKHT SHEHABIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 260-2561
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: 2DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Faridokht "Faye" ShehabiTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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1. Licensee did not provide adequate supervision to a daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Anna Morales conducted an unannounced subsequent complaint visit investigation today and met with Licensee Farodokht Shehabi. The purpose of today's visit was to deliver the investigation finding for the above allegation.

On 12/20/2022, LPA interviewed the Licensee and S(1)who stated that there are five children enrolled at the day care. They stated that on 12/15/2022, there were five children present. Both stated that they always report to the parents/ child representative if they observe any unusual marks such as bruises or scratches. S1 stated that she did not observe the unusual mark on C1 until pick up by the parent/representative.

(page 1)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20221216150828
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SHEHABI, FARIDOKHT
FACILITY NUMBER: 434404637
VISIT DATE: 03/14/2023
NARRATIVE
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On 12/28/202, LPA interviewed two parents who stated that they have no issues or concerns with the day care. When dropping off or picking up, they see three to five children present and Licensee and one staff (S1) They have never seen any their children with any marks or bruises. Records were reviewed including the Children's roster

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation, Licensee did not provide adequate supervision to a day care child did or did not occur, therefore the allegation is UNSUBSTANTIATED.

NOTICE OF SITE VISIT WAS ISSUED AND WAS INFORMED TO LICENSEE TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2