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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415968
Report Date: 06/08/2023
Date Signed: 06/08/2023 10:00:18 AM

Document Has Been Signed on 06/08/2023 10:00 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: 5CENSUS: 4DATE:
06/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Shenas Shahin & Nina FathizadehTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA), Janette Cruz, conducted a case management inspection and met with Licensees, Shenas Shahin and Nina Fathizadeh. Licensees attended an informal office meeting at the San Jose Regional Office on 02/28/23 for violations under Staffing Ratio and Capacity and Criminal Record Clearance. LPA explained purpose of today's inspection to Licensees. LPA toured indoor and outdoor areas of the home. LPA observed four children (one infant, three preschool). LPA reviewed children's and staff files. LPA observed that the facility was in compliance with staff to children ratio/capacity and criminal record clearance requirements.

There were no deficiencies cited. Exit interview conducted with Shenas Shahin and Nina Fathizadeh.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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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