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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416540
Report Date: 02/15/2024
Date Signed: 02/16/2024 04:19:58 PM

Document Has Been Signed on 02/16/2024 04:19 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:NOORI, MASSI & SHAVAKH, DAVIDFACILITY NUMBER:
434416540
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
02/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Massi NooriTIME COMPLETED:
01:10 PM
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On 02/15/2024 at 10:40am, Licensing Program Analyst (LPA) Farida Raja conducted an unannounced Case Management- Licensee Initiated inspection. LPA met with Licensee, Massi Noori and explained the reason for the inspection. The purpose of this inspection is Licensee is requesting a change of capacity to a large family child care home. Licensee has been licensed since 12/10/2022 and has the required one year of experience to apply for a large FCCH. A fire clearance for 14 children was granted on 12/29/2023. Present during today's inspection were Licensee and 4 children including 3 infants and one preschool age. Licensee is not fluent in English and Licensee's adult daughter, Shadi Shavakh helped translate the conversation with LPA via phone.

LPA toured the inside and outside of the home. The off-limit areas of the home are master bathroom, kitchen and attached garage. On limit areas include the master bedroom, sunroom, living room, dining area, two bedrooms and one bathroom. LPA inspected the home for any health and safety hazards. There are sufficient toys for the children in care. All disinfectant, cleaning supplies, and other items that are dangerous to children were inaccessible to children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Last fire drill was conducted and logged on 01/18/2024. Licensee stated that there are no pets or weapons including firearms in the home. LPA reminded Licensee that baby walker or bouncers are not allowed in the home.

Backyard was observed to be fenced. The off-limit areas outside include the front yard, right and left side areas of the backyard. LPA observed that the bricks lining the floor on the left side area of the backyard are uneven and can be a tripping hazard. Licensee stated that children do not use that area of the backyard and LPA advised that children be supervised at all times while outdoors. LPA observed open fertilizer bags and used charcoal in a pot in the backyard. The shed in the backyard was open and LPA observed paint and garden tools stored inside. Licensee stated that they have not been taking children outdoors because of the rain. LPA informed licensee to place items like fertilizers and charcoal out of reach of children and inside the shed and to keep shed locked and inaccessible to children in care. There were no bodies of water observed during today's inspection.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NOORI, MASSI & SHAVAKH, DAVID
FACILITY NUMBER: 434416540
VISIT DATE: 02/15/2024
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LPA observed three cribs in the sunroom that did not have any toys or blanket placed inside them. LPA observed pacifiers without any attachments. LPA provided Licensee with PIN 20-24-CCP during today's inspection. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA observed the bedroom used for napping. LPA informed licensee that if an infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

Adults 18 and over living in the home are Licensee, spouse and one daughter. All adults have cleared criminal record, child abuse, and TB test. 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.

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 shall be either 12 children, no more than four of whom may be infants; or 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. When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC 9150 (Parent Notification Additional Children in Care). Licensee needs to obtain an LIC 9149 (Property Owner/Landlord Consent) if she plans to care to over 12 children and up to 14 children. 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.
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.

As a result of today's inspection, there were no deficiencies cited. Licensee was informed that a Large Family Child Care Home License will be granted upon Supervisor's approval. Exit interview conducted and report was reviewed with licensee, Massi Noori and translated by Licensee's daughter, Shadi Shavakh via phone.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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