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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403322
Report Date: 07/12/2023
Date Signed: 07/12/2023 04:05:00 PM

Document Has Been Signed on 07/12/2023 04:05 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:AKBARI-FEO, MARIAFACILITY NUMBER:
434403322
ADMINISTRATOR:AKBARI-FEO-, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 371-7863
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Maria Akbari-FeoTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst's (LPAs) Elizabeth Berumen and Teodoro Trujillo conducted a case management inspection. Present during the inspection was Assistant, Maria Saucedo and 9 day care children (2 infants & 7 preschoolers). Assistant, Mayra Coti arrived at 12:32 PM.

During the inspection LPAs observed that two infants were asleep in cribs with blankets. Licensee is not complying with safe sleep regulation section 102425 (b) which is cited on following page 809D.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS ALONG SIDE THIS REPORT (page 809 and 809d)

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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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Document Has Been Signed on 07/12/2023 04:05 PM - It Cannot Be Edited


Created By: Elizabeth Berumen On 07/12/2023 at 12:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: AKBARI-FEO, MARIA
FACILITY NUMBER: 434403322

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2023
Section Cited
CCR
102425(b)

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Infant Safe Sleep
Cribs or play yards shall be free from all loose articles and objects.
This requirement was not met as evidenced by; infant 1 and 2 were observed sleeping in cribs with
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Licensee immediatly removed blankets from the crib. Licensee also agrees to submit a written plan of correction stating she understands the Safe Sleep Regulation 102425 and how she will ensure the crib is
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blankets. This poses an immediate health and safety risk to children in care.
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free of any lose articles and objects.
Plan of correction due date July 13, 2023.
AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mary Segura
LICENSING EVALUATOR NAME:Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023


LIC809 (FAS) - (06/04)
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