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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416155
Report Date: 02/22/2023
Date Signed: 02/22/2023 12:56:17 PM

Document Has Been Signed on 02/22/2023 12:56 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-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: 8DATE:
02/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Mehrnaz CarastanTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Pietro Hernandez and Farida Raja, conducted an unannounced Case Management - Deficiencies visit at the home today. LPAs met with Licensee, Mehrnaz Carastan, and explained the nature of today's visit. Present in the home were eleven (8) day-care (5 preschool age and 3 infant) children with the Licensee. This resulted during the course of conducting a subsequent complaint visit to the child care facility to deliver findings. LPAs met with Licensee Mehrnaz "Naz" Carastan and Assistant Ashley Hernandez.

On 1/19/2023: During the course of the investigation, LPA Hernandez observed the children using the downstairs bathroom which is off limits. On 2/7/2023: the Licensee stated that the second floor bathroom had broken down a few times in recent months and the downstairs bathroom was used by the children under supervision.

Licensee now understands that any changes to the use of the home such as going from "off limits" to "on limits areas" need to be approved through a fire inspection and the Community Care Licensing in advance.

A deficiency is being cited based on the LPAs 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: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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 02/22/2023 12:56 PM - It Cannot Be Edited


Created By: Pietro Hernandez On 02/22/2023 at 12:36 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: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2023
Section Cited
CCR
102416.3(a)(6)

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102416.3(a)(6) Prior to making alterations or additions to a family child care home[...] licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
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BY POC DUE DATE 3/1/2023: Licensee agreed to submit a written plan of action regarding how Licensee will ensure that facility is in compliance with Title 22 Regulation Section 102416.3(a)(6). to CCLD.
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LPAs learned through observation and interviews that the off-limit downstairs bathroom was being used for the children in care. This poses a potential risk to the health and safety of 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: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023


LIC809 (FAS) - (06/04)
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