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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415968
Report Date: 10/04/2023
Date Signed: 10/05/2023 01:53:27 PM


Document Has Been Signed on 10/05/2023 01:53 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/05/2023 10:46 AM

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

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On 10/4/2023, Licensing Program Manager (LPM) Joel Segura and Licensing Program Analyst (LPA) Melvin Matos met with licensees, Shahin Shenas & Nina Fathizadeh at an alternate location, as the licensed facility is currently not occupied, for the purpose of serving a Temporary Suspension Order (TSO) for the Family Child Care Home and Exclusion Actions against licensees, Shahin Shenas & Nina Fathizadeh

Summary of charges:

1. On October 2, 2023, the licensees did not ensure a pool at the facility was inaccessible to children in care, causing the deaths of two children and injury to another..

The Department has determined Shenas’ and Fathizadeh's continued or future contact with clients or presence in any facility licensed by CDSS constitutes a threat to the health and safety of the children in care. All families receiving services should be notified of the action taken by the Department.

Licensing Program Manager, Joel Segura, explained the appeal rights to the licensees, including the process to file a Notice of Defense. Summary of Charges packet was left for the parents of the children enrolled in the daycare and the Temporary Suspension Order (TSO) was posted on the front door of the licensed facility as per Title 22 Regulations. The licensees understand that the TSO must remain posted and the removal or concealment of the notice while the temporary suspension order is in effect is punishable as a misdemeanor with a fine up to $500.00, under section 1596.8895 of the California Health and Safety Code. The licensees further understand that if a hearing is requested, this Order will remain in effect until the Department issues a final Decision in the matters contained by the Accusation, or 30 days after the Department receives a Proposed Decision, whichever is sooner.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Joel SeguraTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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