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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416541
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:02:05 PM

Document Has Been Signed on 04/11/2024 02:02 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SAFFARI, MONIREHFACILITY NUMBER:
434416541
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Saffari, MonirehTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On 4/11/24, at 11:20AM, Licensing Program Analyst (LPA) Doni Fici conducted an unannounced Required- 1-Year inspection. LPA met with Licensee, Saffari, Monireh and explained the reason for the inspection. The purpose of this inspection is Licensee also applied for a change of capacity from a small Family Child Care Home (FCCH) to a large FCCH. Licensee has at least one year of experience as a licensee of a small FCCH to apply for a large FCCH. A fire clearance was granted on 03/08/2024. There were six (6) children present during today's inspection.

There is an area to post required postings, such as license and notification of parent's rights. The hours of operation are Monday through Friday 7:30AM to 5:30PM. Licensee does have liability insurance. The proof of control of property is on file.

LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home is the garage. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. There are toys and equipment for children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 2/29/2024. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard is used for children to play. The backyard is fenced. the Off limit area to the outside of the home is the sides of the back yard which is fenced. There are toys and equipment for children. LPA reminded Licensee to check all plastic play structures for any cracks.

Licensee does not transport children, and Licensee understands that children cannot be left alone and unattended in parked vehicles.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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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: SAFFARI, MONIREH
FACILITY NUMBER: 434416541
VISIT DATE: 04/11/2024
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LPA 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. LPA 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 does not have any children that need any kind of IMS services.

A copy of the facility roster was obtained during today's inspection. 6 child's file was reviewed during today's inspection.

Licensee has a valid CPR/1st Aid, which expires on 02/2025. Licensee completed the Mandated Reporter training on 10/27/2022. Licensee was reminded that the Mandated Reporter training requires renewal every two years.

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
Page: 2 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: SAFFARI, MONIREH
FACILITY NUMBER: 434416541
VISIT DATE: 04/11/2024
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LPA reminded Licensee that when Licensee does not have an assistant, Licensee can only care for up to 8 children at any one time in the home.

Licensee is the only adult living in the home. 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.

During the exit interview, the LICENSEE Saffari, Monireh, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Licensee was advised that upon review and approval of Licensing Program Manager a license for a large Family Child Care Home will be granted and issue.

No deficiencies were issued as a result of this inspection.

Exit interview conducted with Licensee, and report was reviewed and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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