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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416155
Report Date: 02/07/2023
Date Signed: 02/07/2023 11:35:11 AM

Document Has Been Signed on 02/07/2023 11:35 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:CARASTAN, MEHRNAZFACILITY NUMBER:
434416155
ADMINISTRATOR:MEHRNAZ CARASTANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 705-0505
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
02/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Mehrnaz CarastanTIME COMPLETED:
11:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Pietro Hernandez, Farida Raja, and Licensing Program Manager (LPM) Gladys Kuizon conducted an unannounced Case Management - Deficiencies visit at the home today. LPAs and LPM met with Licensee, Mehrnaz Carastan, and explained the nature of today's visit. Present in the home were eleven (11) daycare (6 preschool age and 5 infant) children with the Licensee. This resulted during the course of conducting a subsequent complaint visit to the child care facility to continue the investigation. LPAs met with Licensee (S1) Mehrnaz "Naz" Carastan and explained to her the purpose of the inspection. Daughter (S2) Halleh Akhari was present and Assistant (S3) Ashley Hernandez arrived at 9:00 AM.

Copies of records including children's roster were obtained and staff interviews were conducted. 11 children were present during inspection. C1-C6 were pre-school age and C7-C11 are infants.

Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is being cited based on the LPAs amd LPM's observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, An exit interview was conducted, and Plan of Corrections were reviewed and developed with the licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Mehrnaz Carastan, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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 02/07/2023 11:35 AM - It Cannot Be Edited


Created By: Pietro Hernandez On 02/07/2023 at 10:42 AM
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: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2023
Section Cited
CCR
102416.5(d)(1)

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102416.5 Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home...(1) Twelve children, no more than four of whom may be infants.This requirement is not met by:
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By the POC Date 2/8/2023: The Licensee will submit in writing a plan of correction to the CCLD office establishing how she will be in capacity/ratio compliance in the future.
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Based on observation, interview, and records review, the Licensee did not maintain capacity ratio by having 5 infants in care at one time. The maximum infants allowed under this license is 4. This poses an immediate, Health, Safety risk to the children in care.
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


LIC809 (FAS) - (06/04)
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