434412483-2-17-2026-07-CC-JBER-DRDVRG-20260217153956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412483
Report Date: 02/17/2026
Date Signed: 02/17/2026 03:40:18 PM

Document Has Been Signed on 02/17/2026 03:40 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SAGHEBI, FARIBA		FACILITY NUMBER:	434412483
ADMINISTRATOR/ DIRECTOR:	SAGHEBI, FARIBA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 648-6061
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/17/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Fariba Saghebi - Licensee		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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	On 02/17/2026, Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Licensee, Fariba Saghebi, for an unannounced Annual/Random Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were no children in care and the Licensee stated she had no children enrolled and did not intend to open the facility up for enrollment until August 2026. Licensee was present along with her spouse, who are the only adults, over the age of 18, residing in the home. Licensee has a poster board that is placed near the front door with all of the required postings. Licensee, Fariba Saghebi 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. All adults have criminal record clearance and are associated on the Guardian Roster for the facility. Licensee has not had children in care since 2020. LPA reminded the Licensee of the requirement to keep an updated facility roster (LIC9040) with the names of children in care and emergency contacts for up to three years after the child is no longer in care. Licensee was reminded that a fire/disaster drill must be conducted every six months and recorded on a facility fire/disaster drill log to be accessible at all times to Licensing for review. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAGHEBI, FARIBA	FACILITY NUMBER: 434412483
	VISIT DATE: 02/17/2026

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LPA observed a fully charged 3A40BC fire extinguisher that was manufactured more than a year ago and had not been serviced in the past year. LPA reminded the Licensee of the State Fire Marshall requirement of servicing or purchase a new fire extinguisher annually. LPA observed a fully functioning smoke detector and carbon monoxide detector. Licensee does not have children in care who require Incidental Medical Services and does not administer medication at this time.

Incidental Medical Services (IMS) policy was discussed. 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/.

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas of the home (indoors): three (3) bedrooms, one (1) bathroom, and the garage. There is a glass insert into the wall that mimics a fireplace with lighting, but it does not emit heat or gets warm. Licensee has age-appropriate materials, toys, and play equipment currently stored in the garage. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Licensee stated that children would bring their own water bottles from home and she would provide filtered water as needed. Licensee stated she would provide an AM/PM snack along with breakfast and lunch to the day care children. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone in the facility. There are firearms and ammunition in the home. LPA observed fire arms stored in a large locked safe and ammunition was stored in a separate locked cabinet in accordance with written directives.

The backyard area of the home was inspected. LPA observed a grassy area that was fenced in. Off-limit areas outside of home include: both side yards, front yard and part of the backyard. No outdoor bodies of water were observed during todays inspection.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the Licensee, Fariba Saghebi, including the Individual Infant Sleeping Plan (LIC9227).

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAGHEBI, FARIBA	FACILITY NUMBER: 434412483
	VISIT DATE: 02/17/2026

NARRATIVE

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LPA reminded Licensee that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled. Infants should be supervised while sleeping and documentation of sleep checks every 15 minutes should remain in the infant’s file. Documentation should include the time of the check, the infant’s physical condition, and initials of the staff member checking on the infant.

LPA discussed the safe sleep regulations with Licensee, Fariba Saghebi, 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, Fariba Saghebi 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.

No children’s files were reviewed during todays inspection. LPA reviewed and provided LIC311D with the Licensee as a reference for all required documents for children's records, personnel records and facility documents. LPA reminded the Licensee the following documents were required for children in care: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC282) - if Liability insurance is not purchased, Immunization Records (PM286). If infants are enrolled prior to 12 months old the LIC9227 must be filled out, and all children under 24 months must have an individual sleep log that documents a sleep check every 15 minutes. Documentation must include the name of the child, date and time of the check along with the condition of the child and the initials of the staff person that completed the check. This documentation should be kept in the child's file indefinitely.

LPA reviewed the Licensee's file. Immunization records showing immunity to measles (MMR), pertussis (Tdap), and a statement declining influenza were present. A valid CPR/First Aid certificate was not present during today's inspection. LPA observed a Health and Safety Course Certificate from 2011 that did not include the Nutrition training and Lead Poisoning course.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAGHEBI, FARIBA	FACILITY NUMBER: 434412483
	VISIT DATE: 02/17/2026

NARRATIVE

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LPA provided the updated requirement for the Health and Safety course and provided the Licensee with a link to EMSA approved courses where the classes could be completed. This will be required for the facility to be compliant when children are enrolled.

LPA reminded the Licensee when a helper is hired or if her spouse becomes her helper a completed personnel file will also need to include: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate which meets the requirements for AB1207. The Licensee has current Mandated Reporter Training that was completed through the Santa Clara Unified School District. LPA did not observe that this course met the requirements for AB1207 and provided Licensee with www.mandatedreporterca.com in order to complete the correct course to meet the requirement. LPA reminded Licensee that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that 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 www.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.

Licensee stated she would like to add Bedroom #2 and Bedroom #3 for the use of the day care. LPA reviewed the rooms and observed them to be free of hazardous items that could pose a potential risk to children in care. The last fire clearance was dated 02/12/2016 and stated bedrooms #2 and #3 were off limits. LPA will order an updated fire inspection to determine if the bedrooms can be added to the license.

LPA collected the following documents during today's visit:

Updated LIC279 - Correcting adults in the home
Updated LIC999 - Adding two rooms to the on limits areas

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAGHEBI, FARIBA	FACILITY NUMBER: 434412483
	VISIT DATE: 02/17/2026

NARRATIVE

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LPA reminded Licensee before children can be enrolled in the day care the following items need to be addressed:

Fire Extinguisher serviced
CPR/First Aid Course Completed (EMSA Approved)
Health and Safety Course - Including Nutrition and Lead Poisoning Training (EMSA Approved)
Mandated Reporter Course completed meeting the requirement of AB1207

Changes to the on limits areas of the facility will not be updated until a fire clearance is received providing approval to the Department and managerial review is conducted.

As a result of todays inspection, two (2) Technical Violations were issued, more details on the attached LIC9102TV. Exit interview conducted with Licensee. Report was reviewed and provided with Licensee, Fariba Saghebi, along with appeal rights. During the exit interview, the Licensee Fariba Saghebi, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026

LIC809 (FAS) - (06/04)

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