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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417223
Report Date: 02/25/2025
Date Signed: 02/25/2025 12:42:43 PM

Document Has Been Signed on 02/25/2025 12:42 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:SHAGHASI, FARIHAFACILITY NUMBER:
274417223
ADMINISTRATOR/
DIRECTOR:		FARIHA SHAGHASIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 289-8519
CITY:SALINASSTATE: CAZIP CODE:
93908
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/25/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Shaghasi, FarihaTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 2/25/2025 at 10:05 AM, Licensing Program Analyst (LPA) Liridon Fici- Doni conducted an announced Pre-licensing inspection in response to a request for a change of location. LPA met with Shaghasi, Fariha, Applicant, and explained the nature of today’s visit. LPA notes that the Applicant is currently licensed at 2462 Fallingtree Dr, San Jose, CA 95131 (Facility number: 434415205). LPA toured the inside and out of the home and did not observe any bodies of water such as pools or hot tubs.

The Applicant states that adults, over the age of 18, residing in the home is the applicant. The Applicant has no additional adults nor children living in the home. LPA advised that children living in the home will be included in the home ratio and capacity until they turn 10 years of age.
The hours of operation for the family child care home (FCCH) will be Monday - Friday, 6:00AM-6:00PM and the Applicant is planning to offer care for children ages zero (0) months to 12 years of age. The Applicant has submitted a lease agreement and does not currently have liability insurance for the day care. LPA advised the Applicant to provide parents with Affidavit Regarding Liability Insurance (LIC282) upon registration until liability insurance is purchased in the future.

The Applicant was 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA toured inside the home and observed sufficient materials and play equipment for day care children.


Off limits inside the home include: Entire master bedrooms 2 and 5.
Off limits to the outside of the home include: none.
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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: SHAGHASI, FARIHA
FACILITY NUMBER: 274417223
VISIT DATE: 02/25/2025
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LPA reviewed and observed applicants valid first aid/CPR (expires on: 10/17/2025), and valid mandate reporting training (expires on: 12/13/2026).
LPA observed the backyard is fenced all around with a height of 58 inches and 5 inches in between each bar. LPA advised if there are changes to the on/off limits of the home to submit an updated facility sketch (LIC999A) to the San Jose Regional Office. There is a working cell phone at the FCCH. The Applicant currently has six (6) cots, two (2) cribs, and toys for the children to use. LPA advised that mattress sheets should be changed between infants, if the crib is shared, and infant sheets shall be washed daily.

The Applicant states that she will provide medication and Incidental Medical Services to children on a case by case basis. The Applicant states that all food/formula will be provided by the parents of children enrolled and she will warm children''s food as needed at her home. Children will bring water in water bottles if needed. The Applicant has five (5) high chairs available for feeding infants. LPA observed kitchen knives properly stored inaccessible to children in the off limits area in the kitchen. There are no firearms 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. The Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Applicant stated she does plan on caring for children who take medication. LPA informed applicant to submit an IMS plan to CCL if she plans to care for children using medication.

The Applicant is planning to care for infants and has a baby changing pad, waste bin with a tight-fitting lid, and proper storage for diapers and wipes. There is a sink that is easily accessible in the kitchen for use, if needed. LPA observed no set up in the home and applicant was informed to have the day care set up prior to being licensed.

The Applicant states that she is currently planning to use any outdoor space for caring for children. LPA advised that if she plans to not use outdoor space in the future, to submit an updated facility sketch (LIC999A).
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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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: SHAGHASI, FARIHA
FACILITY NUMBER: 274417223
VISIT DATE: 02/25/2025
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LPA observed fully charged 3A40BC fire extinguisher, functioning smoke detector and carbon monoxide detector. LPA advised completing annual maintenance for the fire extinguisher. The Applicant was provided fire/emergency disaster drill log and was advised drills should be completed every 6 months.

The Applicant stated she will speak to the children, and parents of the children to ensure all children are behaved and do not repeat the same behavior. The Applicant understands that children's personal rights should not be violated; including no corporal punishment. Children should not be left for extended periods of time in furniture such as a high chair or play pen.

LPA discussed isolation of sick children with the Applicant and she stated the child will not be admitted into care. If a child were to start feeling sick at her home, parents will be called to pick the child up and the child will be placed in a separate room with another adult staff to ensure their safety while the child is waiting for their parent(s). The child will would be isolated on a napping mat, until the parent/guardian arrives to pick-up. The Applicant stated there are empty rooms for children to use along with utilizing the restroom if the child's symptoms need close restroom access. LPA observed the Applicant has a first-aid kit, and thermometer, available in her home.

LPA additionally discussed supervision of children, unusual incidents (LIC624B), and requirements for additional staff/ adults living in the home. The Applicant states that she does not plan to transport children. The Applicant additionally understands that she must be home at least 80% of the time FCCH is open.

LPA reviewed child care capacity requirements with the Applicant and provided copy of 102416.5 Staffing Ratio and Capacity from California Code of Regulations. The Applicant is not planning to care for more than 14 children at any time. There should never be more than four infants, children under two years of age, present at the FCCH.

LPA reviewed with the Applicant LIC 311D- Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted...

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

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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: SHAGHASI, FARIHA
FACILITY NUMBER: 274417223
VISIT DATE: 02/25/2025
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Entrance Checklist was provided to the applicant. LPA discussed required postings with Applicant and provided copies of Parents Rights bulletin (PUB394) and Earthquake Preparedness Checklist (LIC9148). LPA discussed Provider Information Notices (PINs). LPA additionally reviewed CCLD website and online annual fee payment.

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 platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA discussed the safe sleep regulations with the Applicant and provided 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 informed Applicant that Infants 12 months (1 Year old) and under will use the Lic9227 (Individual Infant Sleep Plan) and conduct 15-minute sleep logs, and Infants 1 year old and above will continue the 15-minute sleep log until age 2 years old.



The Applicant was informed of the MyChildCarePlan.org website; 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.

LPA advised the Applicant that the FCCH license will be issued pending manager review and approval.

Exit interview conducted and report was reviewed and provided to the Applicant, Shaghasi, Fariha



Page 4 of 4.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4