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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415968
Report Date: 02/28/2023
Date Signed: 02/28/2023 02:09:59 PM

Document Has Been Signed on 02/28/2023 02:09 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
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: 8CENSUS: 0DATE:
02/28/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shahin Shenas & Nina FathizadehTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Janette Cruz, and Licensing Program Manager (LPM) Diana Stephenson, conducted a scheduled informal office meeting at the San Jose Regional Office with Shahin Shenas and Nina Fathizadeh, Licensees. The purpose of today's meeting : 1) Discuss staffing, ratio and capacity for a small Family Child Care Home 2) Discuss regulations on obtaining criminal record clearance for all adults residing, working or volunteering inside the home.

The Facility was issued a "Type A" deficiency on January 19, 2023, - Section 102416.5(b)(1) - Staffing Ratio and Capacity - of Title 22 regulations as a result of not being in compliance with the ratio requirements for the small Family Child Care Home license.

The Facility was also issued another “Type A” deficiency on 1/19/23 as per Section 102370(d) - Criminal Record Clearance - of Title 22 regulations for not being in compliance of obtaining criminal record and child abuse index clearances for an adult individual working in the home.

LPM explained to the Licensees that if there are continued deficiencies cited for child ratio and obtaining criminal record and child abuse clearances, the Facility may be referred to legal for possible administrative action, which could include revocation of the Facility license. The Facility will be monitored more frequently to ensure that the Facility is in compliance with the Department regulations.

On 01/19/23, The Licensees had submitted a written plan stating their understanding that they cannot exceed their license capacity. LPA and LPM reminded Licensees that they need to be in compliance with the ratio and capacity requirements at all times.

On 01/20/23, The Licensees obtained live scan fingerprint for Ivonne Vanessa Tovar and criminal record clearance was issued on 1/31/2023 as per Guardian.

LPA and LPM also discussed with Licensees regarding capacity increase application and their options.

An exit interview was conducted with Shahin Shenas and Nina Fathizadeh, Licensees.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2023
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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