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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434404637
Report Date:
03/15/2023
Date Signed:
03/15/2023 03:33:04 PM
Document Has Been Signed on
03/15/2023 03:33 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:
SHEHABI, FARIDOKHT
FACILITY NUMBER:
434404637
ADMINISTRATOR:
FARIDOKHT SHEHABI
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 260-2561
CITY:
SANTA CLARA
STATE:
CA
ZIP CODE:
95051
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
03/15/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Shehabi Faridokht
TIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Anna Morales conducted a CASE MANAGEMENT visit and was greeted by Licensee Faridokht Shehabi. The purpose for the visit was to deliver an Amended report that was created on 3/14/2023.
No deficiencies were cited at today's visit. Exit interview was conducted with Licenseei.
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Anna Morales
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/15/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/15/2023
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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