434417454-1-2-2025-07-CC-AYAG-DCJQJ2-20250102111202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417454
Report Date: 01/02/2025
Date Signed: 01/02/2025 11:12:25 AM

Document Has Been Signed on 01/02/2025 11:12 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:	NOORI, MASSI & SHAVAKH, DAVID		FACILITY NUMBER:	434417454
ADMINISTRATOR/ DIRECTOR:	MASSI NOORI&DAVID SHAVAKH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 282-9179
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/02/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	David Shavakh & Massi Noori		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/02/2025, at 9:00 AM, Licensing Program Analysts (LPAs) Andy Yang and Syeda Bahar, met with Applicants, David Shavakh & Massi Noori to conduct an announced Pre-licensing inspection for a Large Family Child Care Home (FCCH). Present for this inspection are Applicants, Daughter (Shadi), and Daughter's child. Daughter, Shadi, and child do not live in the home. Daughter is here today to provide translation for her parents. The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday to Friday 7:30 AM to 5:00 PM. The age range for children enrollment is from 0 to 4 years old. The home is single family home. The home consists of garage, 2 living rooms, 2 bedrooms, bathroom, master bedroom, master bathroom, kitchen, dining room, family room, backyard and 2 side yards. The two fire places are barricaded. Fire clearance for the large FCCH was approved on 12/10/2024. Per fire clearance, all areas were approved except one bedroom and garage. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are two living rooms, bathroom, one bedroom (right side of hallway), master bedroom, master bathroom, kitchen, dining room, and entire backyard. The OFF LIMIT AREAS are garage, and one bedroom (located at end of the hallway) which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the bedroom. The outdoor play area is free from defects or dangerous conditions and is fenced. There is a jacuzzi located on the right side yard. Jacuzzi is covered by a hot tub hard cover which is locked with a snap lock, and a tarp covering on top with snap locks. LPA reminded applicants shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool covers, and shall be made inaccessible when not in use by removing or making the ladder inaccessible. There are ample age-appropriate toys that appear to be safe and in good condition. All hazardous materials and toxins are kept out of the reach of children, and it was observed that there are no toxins or hazardous items accessible today. Applicant states that any poisons are stored in garage which is OFF LIMITS and in a locked shed in backyard. LPA reminded Applicants that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. *Continue Page 2*

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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: NOORI, MASSI & SHAVAKH, DAVID	FACILITY NUMBER: 434417454
	VISIT DATE: 01/02/2025

NARRATIVE

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The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The Applicants CPR and First Aid certificate is current and expires on 10/2026. Applicants completed the Mandated Reporter Training for Child Care Providers on 10/26/2024 (expires on 10/2026) and a copy of the certification is on file. Applicants were reminded of Mandated reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the Applicant’s immunization is on file. Per Applicant, there are no firearms in the home.

Applicant states that she will not administer any medication to the children at this time. Applicant states that a child will be isolated in the ISOLATED AREA if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home. Also discussed with Applicant the requirements for reporting suspected child abuse, unusual incidents/injuries, and heat related illnesses.

Forms of discipline to be used by Applicant is talking and redirecting the child. Applicant understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature. LPA informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Applicant provided proof of control of property to the Department prior to today’s inspection and a copy of the grant deed is on file. Applicants stated that they will have day care insurance. LPA reminded that if Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families until she obtains liability insurance in the future.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: NOORI, MASSI & SHAVAKH, DAVID	FACILITY NUMBER: 434417454
	VISIT DATE: 01/02/2025

NARRATIVE

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Applicants were reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA reviewed with the Applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Pre-licensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

On this date, 11/22/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: NOORI, MASSI & SHAVAKH, DAVID	FACILITY NUMBER: 434417454
	VISIT DATE: 01/02/2025

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicants, David Shavakh & Massi Noori. LPA advised the Applicant that a Large Family Child Care Home license will be approved pending Licensing Program Manager’s review.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

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