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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434404637
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:01:25 PM

Substantiated


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
01/13/2023 and conducted by Evaluator Pietro Hernandez
COMPLAINT CONTROL NUMBER: 07-CC-20230113104328
FACILITY NAME:SHEHABI, FARIDOKHTFACILITY NUMBER:
434404637
ADMINISTRATOR:FARIDOKHT SHEHABIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 260-2561
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: 4DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:SHEHABI, FARIDOKHTTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff caused facial bruising to a child in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pete Hernandez and Licensing Program Manager (LPM) Gladys Kuizon made a subsequent unannounced site visit to deliver findings to the Licensee Faridokht Shehab. The LPA and LPM explained the purpose of the visit to the Licensee.

On 01/13/2023, the Department received the above allegation against the facility. The Community Care Licensing Division - Investigations Branch conducted a full investigation and interviewed licensee, staff, parents, and potential witnesses. Facility records, police and medical reports, and photos were obtained.

The investigation revealed that on 12/15/2022, child (C1) obtained a red bruise on C1's face extending to C1's ear. Licensee and assistant, Hengameh Sefati, confirmed C1 did not have the bruise when dropped off for care that day and was observed with the bruise during pick up. Licensee and Hengameh stated they did not know how C1 obtained the injury. Based on interviews, Licensee left the facility to run errands on 12/15/2022 and Hengameh was left alone with children in care. Licensee confirmed C1 did not have the bruise when Hengameh left.

Continued, see LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
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 3
Control Number 07-CC-20230113104328
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: 03/29/2023
NARRATIVE
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Hengameh stated C1 may have obtained the injury from sleeping on a teething toy, C1's hand, or the playpen. Photos show the shape and pattern of the bruise do not match any of the above. Hengameh also stated C1 was fuzzy that day, was crying most of the time, and will not sleep.

On 12/16/2022, C1 was taken for medical examination. C1's medical records was reviewed by a medical doctor specializing in Child Abuse Services and Prevention (CASP). CASP doctor documented that "The pattern of bruising is very concerning for a handprint-type mark or a strike from another object" and wrote that the significant facial bruising is likely caused by child physical abuse and stated that this conclusion is reached with a reasonable degree of medical certainty based on the information known to date.

Based on evidence obtained during the Department's investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20230113104328
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2023
Section Cited
CCR
102423(a)(4)
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Personal Rights 102423(a)(4) To be free from corporal or unusual punishment, infliction of pain, ...coercion, threat, mental abuse, or other actions of a punitive nature...This requirement was not met as evidenced by:
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The Department served an Immediate Order of Exclusion to licensee and Hengameh today. Failure to comply with the Order of Exclusion shall be grounds for discipline, including suspension or revocation of the licensee's license. LPM and LPA observed Hengameh Sefati leave the facility.
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Based on staff interviews, medical records, and Child Abuse Services and Prevention doctor's review, C1's facial bruising was likely caused by physical abuse. Interviews with licensee and Hengameh revealed C1's injury was sustained while in care. This posed an immediate risk to C1's health and safety.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3