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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409424
Report Date: 07/26/2024
Date Signed: 07/29/2024 04:50:22 PM

Document Has Been Signed on 07/29/2024 04:50 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:PARVIN, SHAHANEWASFACILITY NUMBER:
434409424
ADMINISTRATOR/
DIRECTOR:		PARVIN, SHAHANEWASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 239-0231
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:57 PM
MET WITH:Parvin ShahanewasTIME VISIT/
INSPECTION COMPLETED:
05:25 PM
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On 07/26/2024 at 1:57pm, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection. LPA was granted access to the home by Licensee, Parvin Shahanewas, and explained the nature of today’s inspection. Present in the home were licensee, volunteer and 9 children including 2 infants and 7 preschool age. Licensee's spouse/assistant arrived around 3pm. Days and hours of operation are Monday to Friday, 8:30 am to 5:30 pm. LPA observed all required posted materials, in the family room of the home. Facility has one waiver that allows for a waterfall in the front yard. The waterfall has been filled with plants and a waiver is no longer required. The adults that reside in the home are licensee and spouse. No minor children reside in the home.

LPA toured the indoor and outdoor areas of the home during today's inspection. Children were napping during today's inspection. LPA observed two children (C5 and C6) sleeping with blankets inside play yards. Licensee has a working telephone in the home (408-204-4329). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture and feeding chairs were observed to be without sharp, loose or pointed parts. The home has central heating/cooling and ventilation for comfort of children. The home is single story with 4 bedrooms and 2 bathrooms. Off limit areas inside the home: master bedroom, master bathroom, three bedrooms and attached garage. LPA observed a barricaded fireplace in the family room. Off limit areas outside the home include gated right side section, locked shed and gated left side section. Backyard is fenced. There are no bodies of water observed. LPA advised Licensee to refill tan bark under the play structure as the weed liner is visible underneath the play structure in some areas. LPA advised Licensee to check wooden play structure and items for splinters and nails and replace them or place them in an area off limit to children.

LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free on any hazards.

LPA observed a 3A40BC fire extinguisher in the hallway to the bathroom. LPA reminded licensee that the fire extinguisher needs to be serviced once every 12 months. Licensee has working smoke/carbon monoxide detectors and fire pull station.



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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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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: PARVIN, SHAHANEWAS
FACILITY NUMBER: 434409424
VISIT DATE: 07/26/2024
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 Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee understands that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles and refilled using filtered water. Licensee states that she provides AM snack, lunch and dinner to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 04/16/2024. LPA obtained copy of children's roster.

Children file review was completed and found to be current and up to date. Nine (9) children’s files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA reviewed two (2) infant's files and observed 15-minute nap checks conducted until 04/2024. Licensee stated that she misplaced the other records that show nap checks from May through July. LPA informed licensee to maintain records safely so they can be reviewed during inspections.

LPA discussed the Child Care Licensing Safe Sleep web page 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. Licensee states that a child will be isolated in the living room if necessary due to illness or communicable disease.

Staff file review was completed. LPA reviewed two staff and one volunteer file. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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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: PARVIN, SHAHANEWAS
FACILITY NUMBER: 434409424
VISIT DATE: 07/26/2024
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Licensee has current Pediatric CPR/First Aid certification with an expiration date of 01/06/2025. Licensee and spouse's Mandated Reporter Training expires on 06/13/2025. Licensee and assistant have proof of immunization's for measles, pertussis and statement declining the influenza vaccine.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc. The Department will communicate all new information to providers through Provider Information Notices (PINs). Please sign up to be notified for new PINs at www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and visit the Department’s website for the latest PINs.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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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: PARVIN, SHAHANEWAS
FACILITY NUMBER: 434409424
VISIT DATE: 07/26/2024
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Incidental Medical Services (IMS) policy was discussed. Licensee states that she does not administer any medications or IMS to the day care children at this time. Licensee stated that she may have a new child that requires an Epinephrine Autoinjector. LPA provided licensee with a copy of PIN 22-02-CCP and informed licensee to submit a written incidental medical plan prior to child attending the facility. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee states that she does not transport day care children at this time. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

One Type B deficiency was cited on the attached LIC 809-D page. Appeal rights were provided. Exit interview conducted and report was reviewed with the licensee, Parvin Shahanewas.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/29/2024 04:50 PM - It Cannot Be Edited


Created By: Farida Raja On 07/26/2024 at 04:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PARVIN, SHAHANEWAS
FACILITY NUMBER: 434409424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for two children sleeping in a play yard which poses a potential health, safety or personal rights risk to persons in care. LPA observed two children (C5 and C6) napping in the play yard with blankets inside the play yard. Licensee removed the blankets during today's inspection.
POC Due Date: 07/29/2024
Plan of Correction
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Licensee will review Infant Safe Sleep Regulations and submit a statement of understanding of regualtions especially keeping cribs or play yards free of blankets, pillows, and other loose articles and objects at all times. Licensee will submit the plan of correction by POC due date of 08/02/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024


LIC809 (FAS) - (06/04)
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