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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404637
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:40:36 PM

Document Has Been Signed on 04/04/2023 01:40 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SHEHABI, FARIDOKHTFACILITY NUMBER:
434404637
ADMINISTRATOR:FARIDOKHT SHEHABIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 260-2561
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Shehabi FaridokhtTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA's) Anna Morales and Pete Hernandez conducted a Case Management Visit to confirm that the licensee cleared a deficiency that was cited on March 29,2023. LPA's were greeted by Licensee Faridokht "Faye" Shehabi, and three children present during today's visit. No other staff were present.

On March 29, 2023, Licensee was issued one TYPE A violation under CCR 102423(a)(4), Personal Rights as a result of an Complaint allegation that was deemed Substantiated. LPA's observed that Licensee is in compliance during today's inspection.

LPA's observed a copy of the licensing report dated 3/29/2023 with the Type A deficiency posted next to the front door entrance, and the parents have signed the LIC9224.

Exit interview conducted and report was reviewed with the licensee Faye Shehabi. No deficiencies were cited on today's visit.

Notice of site visit was issued and must be posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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