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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416213
Report Date: 09/20/2024
Date Signed: 09/20/2024 11:57:18 AM

Document Has Been Signed on 09/20/2024 11:57 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NIKFARJAM, MOJGANFACILITY NUMBER:
434416213
ADMINISTRATOR/
DIRECTOR:		MOJGAN NIKFARJAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 663-0082
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
09/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:33 AM
MET WITH:Mojgan NikfarjamTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Mandeep Kaur and Andy Yang conducted an unannounced annual inspection. LPAs met with Licensee Mojgan Nikfarjam and explained the reason for the inspection. Present during today's inspection were Licensee, four children and Licensee's two adult assistants.

The hours of operation are Monday through Friday 8AM to 5:30PM. There is a board to post required postings, such as license and notification of parent's rights. LPAs toured the inside and outside of the home with Licensee. There are age appropriate toys and equipment available for the children. Day Care Areas: living room, kitchen, 1 bedroom, bathroom, and the backyard. Off Limit Areas are the garage and the entire house. Disinfectant and cleaning supplies were inaccessible to children.

LPAs obtained a copy of current children's roster during the inspection. Fire/disaster drill was conducted on
August 05, 2024. LPAs observed a fully charged 2A10BC fire extinguisher, functioning smoke and carbon
monoxide detectors. Licensee states that there are no weapons or firearms in the home.

LPAs reviewed two (2) staff files and Four (4) children's files during today's inspection. The children records reviewed include but not limited to immunization records and notification of parent's rights. LPAs also reviewed sleep log and the LIC 9227. LPAs reminded Licensee that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

Facility provides morning snacks, lunch, and afternoon snacks to the children. Healthy beverages requirements were discussed with Licensee.

Continuation on next pages:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: NIKFARJAM, MOJGAN
FACILITY NUMBER: 434416213
VISIT DATE: 09/20/2024
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LPAs discussed the safe sleep regulations with licensee 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. LPAs also informed licensee 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.

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/.

Licensee was informed of the 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&R's) throughout California.

The adults 18 and over living in the home are Licensee, her spouse and two daughters. All adults have cleared criminal record and child abuse index. Licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

**Continue on next page**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
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: NIKFARJAM, MOJGAN
FACILITY NUMBER: 434416213
VISIT DATE: 09/20/2024
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During the exit interview, the Licensee, Mojgan Nikfarjam confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No Deficiency is issued during today's inspection.

Exit interview conducted and report was reviewed with Licensee, Mojgan Nikfarjam. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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