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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416155
Report Date: 10/03/2024
Date Signed: 10/04/2024 11:44:35 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2024 and conducted by Evaluator Farida Raja
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240424164505
FACILITY NAME:CARASTAN, MEHRNAZFACILITY NUMBER:
434416155
ADMINISTRATOR:MEHRNAZ CARASTANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 705-0505
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 7DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Mehrnaz CarastanTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Neglect/Lack of Supervision resulting in fracture to child
INVESTIGATION FINDINGS:
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On 10/03/2024 at 9:05am, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced complaint inspection and met with Licensee, Mehrnaz Carastan. The purpose of the inspection was to deliver the investigation findings for the above allegation. LPA conducted a facility walk through and observed licensee and one assistant with seven children including four infants and three preschool age.

The investigation of the above allegation was conducted by the Community Care Licensing Division (CCLD) Investigations Bureau (IB). Investigator Rhonda Austin conducted the complaint investigation.
IB Investigator conducted interviews with licensee, staff, parent of child, parents of children in care and other agencies as well as reviewed hospital medical records and other pertinent records during the investigation of the allegation.

Continued on Page 2


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20240424164505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155
VISIT DATE: 10/03/2024
NARRATIVE
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The investigation revealed that on 03/15/2024, child (C1) was dropped off into care with no injuries. Photographs shared by licensee with C1’s parent at 9:42 AM showed C1 playing and not in distress. At 1:25 PM, licensee notified C1’s parent that C1 has been crying continuously since the morning and will need to be picked up. No explanation for the cause of C1’s continuous crying was provided by licensee. C1 was picked up by C1’s parent and was observed not moving arm and flinching when touched on the left arm. C1 was taken to urgent care for further evaluation.

Medical reports were reviewed. Based on reports, C1 sustained a spiral fracture.

Based on observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12, Chapter 1) are being cited on the attached LIC 9099D.

Type A deficiency cited. Civil penalties are being assessed as a result of a serious bodily injury. Exit interview conducted and copy of this report was reviewed with Licensee, Mehrnaz Carastan. Appeal rights provided.

According to AB 633, all parents of children currently enrolled and any future children being enrolled for the next 12 months must be provided with this report which contains this Type A deficiency, obtain the signature of parents in care with form LIC 9224 and keep in the child's file. The licensee understands the requirements.

Licensee refused to sign today's report delivering complaint findings and civil penalty assessment pages.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20240424164505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/04/2024
Section Cited
CCR
102423(a)(2)
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102423 Personal Rights (a) (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
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Licensee will submit a written plan of correction to LPA by 10/04/2024.
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Based on interviews, observations and records reviewed, licensee did not maintain a safe environment due to lack of supervision which resulted in serious bodily injury to a child (C1) in care. This posed an immediate risk to the health, safety and personal rights 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3