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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407418
Report Date: 10/16/2024
Date Signed: 10/16/2024 11:26:04 AM

Document Has Been Signed on 10/16/2024 11:26 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:KHAZENI, MANIJEH & BEYK, MOHAMMADFACILITY NUMBER:
434407418
ADMINISTRATOR/
DIRECTOR:		KHAZENI & BEYKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 736-6310
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
10/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Manijeh Khazeni & Mohammad BeykTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mel Matos met with Manijeh Khazeni & Mohammad Beyk, Licensees, for an unannounced Required - 3 Year inspection. LPA was granted access to the home by the Licensees. LPA also observed two adult assistants (Lucia Saraut & Snigdha Lnu) and seven preschool children in the home during today's inspection. Licensees were operating within the capacity and ratio requirements of the large Family Child Care Home License. LPA observed the required postings, including the facility license, near the front entrance to the day care. Days and hours of operation are Monday - Friday from 8:30 AM to 5:30 PM. Licensees and Licensees two adult children (Koosha & Rasa Beyk) are the adults residing in the home. There are no minor children residing in the home.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on May 15, 2024. Licensees state that they have liability insurance through DCI Insurance for the day care and LPA observed a valid policy (exp: 03/18/25) during today's inspection. Licensees own their home and proof of ownership is on file. Licensees have current CPR and First Aid certifications (exp: 04/19/2025) on file. One adult assistant also has valid CPR & First Aid certifications (exp: 04/2025). Licensees and two adult assistants have the required vaccines (MMR, Tdap, & flu - opt out) and are current with the Mandated Reporter Training for Child Care Workers. LPA reviewed six preschool children's files and the files were complete with the required forms. LPA reviewed four staff files (Licensees & two adult assistants) and the files were complete with the required forms.

LPA toured the indoor and outdoor areas of the home with the Licensees during today's inspection. Licensees have a working telephone in the home. The home is clean, orderly, (including heating/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no stairs inside the home. The main areas of the day care are the back day care room, backyard, and bathroom, located in the back section of the home. Off limit areas in the home: two bedrooms, kitchen, barricaded fireplace (located in the living room), barricaded wall heater in the back day care room, and attached garage. Off limit areas outside the home: one locked storage shed.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensees state that they don't not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to children.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHAZENI, MANIJEH & BEYK, MOHAMMAD
FACILITY NUMBER: 434407418
VISIT DATE: 10/16/2024
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Licensees state that they provide snacks to the day care children. Licensees states that children bring their own lunches from home. Licensees understand that any food brought from home shall be labeled with each child's name and properly stored. Licensees have a first aid kit in the home which includes a touch less thermometer. Licensees states that nobody smokes and they understand that smoking is prohibited in the home.

Licensees do not administer medication to children. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Supervision of children was discussed with the Licensees and they understand that they must be present in the home during day care hours (80% of operating hours) and ensure that the children are supervised at all times. Licensees understand their capacity/ratio options and they understand that they cannot have more than 14 children present in the home without at least two qualified adults present. Licensees state that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensees state that they do not transport any day care children. Licensees understand that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Manijeh Khazeni & Mohammed Beyk, Licensees, were reminded that all adults 18 and over living or working in the home, 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 discussed the safe sleep regulations with the Licensee and discussed 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 also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Exit interview conducted and report was reviewed with the Licensees, Manijeh Beyk & Mohammed Beyk. No deficiencies issued during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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