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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434408377
Report Date:
09/15/2023
Date Signed:
09/18/2023 10:40:45 AM
Document Has Been Signed on
09/18/2023 10:40 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-DAY CARE
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
6
CENSUS:
6
DATE:
09/15/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:10 AM
MET WITH:
Batool Afjei
TIME COMPLETED:
05:50 PM
NARRATIVE
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On 09/15/2023, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Batool Afjei and explained the nature of today’s inspection. Present in the home were licensee, assistant (Marita Vanaky) and 6 infant children. Licensee was
not
operating within the r
atio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:30 am to 5:30 pm. LPA observed all required posted materials near the front entrance to the home. The adults that reside in the home are licensee and spouse/co-licensee.
LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-499-1914). LPA observed sufficient materials, toys, and play equipment for the day care children. The daycare is being operated in the converted garage (living area and one room). LPA observed children playing, eating and napping in the converted garage under the supervision of staff. LPA observed two reclined sleepers in the garage room with an infant (C6) sleeping in one. LPA observed a bouncer/rocker in the garage living area and baby walker in the on-limit family room. The home has central heating/cooling and ventilation for comfort of children. In use areas inside the home: converted garage (living area and one room), one bathroom, family room. LPA observed a screened fire place in the on limit family room. Off limit areas outside the home: fenced swimming pool. LPA observed that the facility pool's fencing has gaps where the panel connects to the access gate on both sides and between where two panels meet in two separate areas of the fence. The gaps are more than 2 inches wide. Backyard is fenced and both sides of the home are gated. The outdoor space and play equipment were observed to be age appropriate and free of hazards. LPA observed that the bathroom used by children was in operating condition.
LPA observed a fully charged 2A10BC fire extinguisher in the hallway to bathroom and working smoke/carbon monoxide detector. The licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were stored inaccessible to children. Licensee understands that smoking is prohibited in the home.
Continued on Page 2
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Farida Raja
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
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
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. LPA observed two reclined bouncers in the garage room with an infant (C6) sleeping in one. LPA observed a bouncer/rocker in the garage living area and baby walker in the on-limit family room. Licensee was reminded that baby walkers, bouncers, exersaucers, johnny jumpers and similar items were not allowed in family childcare homes.
POC Due Date:
09/16/2023
Plan of Correction
1
2
3
4
Licensee will remove all bouncers, walkers and similar items from the family child care home and submit a letter stating understanding of regulations to LPA by Plan of Correction date of 09/16/2023. Licensee removed the four items and placed them in an off limit area during today's inspection.
Type A
Section Cited
CCR
102416.5(b)(2)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. LPA observed 6 infants in the small family home. LPA informed licensee of the ages, ratio and capacity regulatory requirements of her license and provided licensee with a ratio chart providing information on ratio and ages of children in a small family child care home.
POC Due Date:
09/16/2023
Plan of Correction
1
2
3
4
Licensee will submit letter of understanding and Plan of Correction to LPA by 09/16/2023.
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
2
of
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee has not conducted and maintained a log of fire/disaster drills.
POC Due Date:
09/18/2023
Plan of Correction
1
2
3
4
Licensee will conduct and maintain a fire/disaster drill log and submit proof to LPA by Plan of Correction date of 09/18/2023.
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
3
of
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed that the facility pool's fencing has gaps where the panel connects to the access gate on both sides and between where two panels meet in two separate areas of the fence. The gaps are more than 2 inches wide.
POC Due Date:
09/18/2023
Plan of Correction
1
2
3
4
Licensee, Seyed, stated that he will install a mesh to fill all gaps and submit proof to LPA by Plan of Correction date of 09/18/2023.
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
4
of
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above for herself and one staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/29/2023
Plan of Correction
1
2
3
4
Licensee and staff will complete the mandated repertor training and submit proof to LPA by Plan of Correction date of 09/29/2023.
Type B
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensees failed to provide the permit record for the garage which poses a potential risk to the health and safety of children in care.
POC Due Date:
09/18/2023
Plan of Correction
1
2
3
4
Licensee stated that she will move the daycare to the family room and will submit an updated facility sketch indicating which areas of the home will be used for the day care and which will be off limit for children in care.
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
5
of
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above for herself and one staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/29/2023
Plan of Correction
1
2
3
4
Licensee and staff will obtained required immunizations and submit proof to LPA by Plan of Correction date of 09/29/2023.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee did not have a current children's roster.
POC Due Date:
09/29/2023
Plan of Correction
1
2
3
4
Licensee will complete a children's roster and provide proof to LPA by plan of correction date of 09/29/2023.
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
6
of
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in 6 out of 6 children (C1-C6) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/29/2023
Plan of Correction
1
2
3
4
Licensee will maintain complete files for children C1-C6 with required forms including Notification of Parent's Rights (LIC 995A) and submit proof to LPA by Plan of Correction date of 09/29/2023
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
7
of
11
Document Has Been Signed on
09/18/2023 10:40 AM
- It Cannot Be Edited
Created By:
Farida Raja
On
09/15/2023
at
04:13 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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/15/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 6 out of 6 infants which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/29/2023
Plan of Correction
1
2
3
4
Licensee will conduct 15-minute checks on all sleeping infants and submit proof of conducting and documenting checks to LPA by plan of Correction date of 09/29/2023.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Gladys Kuizon
LICENSING EVALUATOR NAME:
Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
8
of
11
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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
VISIT DATE:
09/15/2023
NARRATIVE
1
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32
Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides breakfast, lunch and two snacks to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated.
Licensee did not have a current children's roster and has not maintained a fire drill log. LPA communicated with licensee the importance of maintaining a children's roster and conducting fire drills.
Six (6) children’s files were reviewed during today's inspection. Licensee did not have complete files with required forms for children, C1-C6. Licensee has not conducted and documented 15-minute checks for sleeping infants.
LPA discussed the safe sleep regulations with licensee, including conducting 15-minute checks on all sleeping infants 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 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. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age.
LPA reviewed 2 staff files (Licensee and assistant) for the required forms. Licensee has current Pediatric CPR/First Aid certification (expires 02/2024). A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee and staff do not have the required immunization in file for measles, pertussis and influenza and do not have a current Mandated Reporter Training for Child Care Workers. LPA informed licensee that the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website:
www.mandatedreporterca.com
for additional information on the online training.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and
Continued on Page 3
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Farida Raja
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
9
of
11
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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
VISIT DATE:
09/15/2023
NARRATIVE
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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.
Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time.
LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.
Licensee is encouraged to visit the Department’s website at
https://cdss.ca.gov/inforesources/child-care-licensing
to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. LPA provided a copy of the PIN to Licensee. 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:
https://www.ada.gov/resources/child-care-centers/
.
Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.
Continued on Page 4
SUPERVISORS NAME
:
Gladys Kuizon
LICENSING EVALUATOR NAME
:
Farida Raja
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
10
of
11
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:
AFJEI, BATOOL & GHOREYSHI, SEYED
FACILITY NUMBER:
434408377
VISIT DATE:
09/15/2023
NARRATIVE
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Licensee 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.
During the exit interview, licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process
.
Two (2) Type A and nine (9) Type B deficiencies were cited as a result of today's inspection. Type B and Type A deficiencies were cited today on the attached LIC 809D pages. Appeal rights and LIC 9224 were printed and given to Licensee. Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be given to each existing parent by the end of today or next day child is in care, and to any newly enrolled parents/guardians enrolled over the next 12 months from the date of this report. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.
LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation
.
Exit interview conducted and report was reviewed with the licensee, Batool Afjei. Licensee and co-licensee (Seyed Ghoreyshi) stated that they want to apply for a change in capacity from a small to large family childcare home and wanted to remove spouse's name as co-licensee. LPA informed Batool to submit an updated Application for Family Child Care Home (LIC 279) requesting increase in capacity and licensee name change.
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:
09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/15/2023
LIC809
(FAS) - (06/04)
Page:
11
of
11