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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417454
Report Date: 01/30/2025
Date Signed: 01/30/2025 08:50:37 AM

Document Has Been Signed on 01/30/2025 08:50 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, DAVIDFACILITY NUMBER:
434417454
ADMINISTRATOR/
DIRECTOR:		MASSI NOORI&DAVID SHAVAKHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 282-9179
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/30/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:David Shavakh & Massi NooriTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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On 1/30/2025, at 8:15 a.m., Licensing Program Analysts (LPA) Syeda Bahar and Licensing Program Manager (LPM) Belinda Devall conducted an announced follow up Pre-licensing inspection to the facility. Present for this inspection are Licensees David Shavakh and Massi Noori, two (2) Daughters. Daughter, Shadi, does not live in the home. Daughter is here today to provide translation for her parents.

The initial pre-licensing inspection was completed on 01/02/2025, and the purpose of today's follow up inspection is to complete the pre-licensing process for the (2) fireplaces and a hot tub in the backyard.

Today, LPA inspected the fireplaces and backyard hot tub with the Licensees for compliance.

1) Fireplaces is securely screened and inaccessible to children.

2) Hot tub is covered with side buckle with a strap on it and Licensees acknowledge that they will monitor it regularly to make sure it is inaccessible to children. Licensees also acknowledge that if there is any damage the hot tub will be serviced or replaced.


LPAs conducted an exit interview with Licensees David Shavakh and Massi Noori. Appeal rights provided.
License is effective as of today 1/30/2025.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Syeda Bahar
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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