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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415968
Report Date: 01/30/2023
Date Signed: 01/30/2023 10:41:15 AM

Document Has Been Signed on 01/30/2023 10:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SHENAS, SHAHIN & FATHIZADEH, NINAFACILITY NUMBER:
434415968
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
01/30/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Shahin Shenas & Nina FathizadehTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Janette Cruz met with Shahin Shenas and Nina Fathizadeh, Licensees, for an unannounced Plan of Correction (POC) inspection. LPA also observed four children enrolled (4 infants) and Sina Fathizadeh (Shahin's son) present in the home during today's inspection. LPA reviewed four children's files.

One "Type A" deficiency was issued on 01/19/2023 during a Required- 1 Year inspection. The deficiency was issued under Section 102416.5(b)(1)- Staffing Ratio & Capacity - Licensees had five infants present in the home during the facility inspection conducted on 1/19/23.

The Licensees submitted a written Plan of Correction to LPA Cruz prior to today's inspection in which they indicate that they understand the required ratios for a small Family Child Care Home License. The Licensees state that they understand that they cannot have more than four infants present at any one time. Based on observation, one of the infants was no longer present during inspection and Licensees stated that child, C5, was disenrolled by Licensees on 1/20/23.

LPA observed signed LIC9224 Acknowledgement of Receipt of Licensing Report in the children's files.

LPA concludes that Licensees have completed the required Plan of Correction. No other deficiencies issued during today's inspection. LPA advised Licensees that an Office Meeting will be scheduled at a later date. Written notification of the office meeting will be sent to Licensees via mail.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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