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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416155
Report Date: 10/03/2024
Date Signed: 12/17/2024 02:29:41 PM

Document Has Been Signed on 12/17/2024 02:29 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/
DIRECTOR:		MEHRNAZ CARASTANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 705-0505
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
10/03/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Mehrnaz CarastanTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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*This report has been amended to remove the civil penalties assessment page (LIC 421IM) and the reference to it on the LIC 809-C page.

On 10/03/2024 at 10am, Licensing Program Analyst (LPA) Farida Raja conducted an unannounced case management inspection and met with licensee, Mehrnaz Carastan. LPA informed license of the purpose for today’s inspection. LPA conducted a facility walk through and observed licensee and one assistant with seven children including four infants and three preschool age.

During the course of the complaint investigation, facility staff were interviewed and stated that children go to the downstairs bathroom to change their clothes and use the bathroom. Diapers are also changed in the downstairs bathroom. Staff also stated that the second floor is used as an isolation area when children need to be isolated due to illness or communicable disease. As per Fire Safety Inspection Report obtained on 11/24/2020, fire clearance is not granted for areas other than living room, family room and bathroom on the first floor. The second floor, garage and basement are off limits to children in care. LPA informed licensee that for a large family childcare license, a fire clearance is required prior to conducting daycare operations in off limit areas. Licensee was previously advised during an inspection conducted on 02/22/2023 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.

Based on review of text messages during the complaint investigation, Licensee informed parent that C1 needs to nap or be quiet and stay on the bed during the scheduled nap time from 1-3pm thus forcing the child to remain in a designated sleeping area. LPA informed Licensee of infant safe sleep regulations in which no infant shall be forced to sleep or stay in a designated sleeping area.

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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.

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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155
VISIT DATE: 10/03/2024
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Based on interview with Licensee during the complaint investigation, Licensee’s conduct is inimical to the welfare and safety of children in care as she provided false statements to the investigator stating that has not observed any children climbing out of the highchair and that she only uses a highchair for children under 1 year and is not currently using the highchair for any children, but text messages exchanged between licensee and parent show that child C1, who was over 1 year old, was placed in a highchair from which C1 continued to climb out of.

Upon review of infant's (C3) files during today's inspection, LPA observed that child, C3 does not have a completed Individual Infant Sleep Plan (LIC 9227). LPA reviewed safe sleep regulations with Licensee and provided licensee with a copy of the Individual Infant Sleep Plan (LIC 9227) during the inspection.

In areas that were evaluated, three (3) Type A and one (1) Type B violation was observed and cited on the attached LIC 809D pages. Civil penalties were issued. 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.

Exit interview conducted and report was reviewed with Licensee, Mehrnaz Carastan. Licensee will be invited to attend a Non-Compliance Meeting in the San Jose Regional Office at a date and time to be determined at a later date.

Licensee refused to sign today's case management deficiencies report.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE 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
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Page: 2 of 5
Document Has Been Signed on 10/04/2024 11:46 AM - It Cannot Be Edited


Created By: Farida Raja On 10/03/2024 at 09:44 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: 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
102371(a)

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102371 Fire Safety Clearance (a) A fire safety clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal shall be required for a large family child care home. This requirement is not met as evidenced by:

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Licensee to submit a written plan of action to LPA by plan of correction date of 10/04/2024.
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Based on licensee and staff interviews, they stated that the basement bathroom and the second floor is used by daycare children. Based on 11/24/2020 fire clearance report, fire clearance is not granted for the second floor, garage and basement. This poses an immediate risk to the health and safety of children in care.
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Request Denied
Type A
10/04/2024
Section Cited
CCR102425(e)

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102425 Infant Safe Sleep (e) No infant shall be forced to sleep, to stay awake, or to stay in the designated sleeping area.

This requirement is not met as evidenced by:
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Licensee to review infant safe sleep regulations and submit a written plan of correction to LPA by 10/04/2024
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Based on text messages obtained, Licensee informs parent that C1 needs to nap or be quiet and stay on the bed during the scheduled nap time from 1-3pm thus forcing the child to remain in a designated sleeping area. This poses an immediate 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: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


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Document Has Been Signed on 10/04/2024 11:46 AM - It Cannot Be Edited


Created By: Farida Raja On 10/03/2024 at 09:46 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: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
10/04/2024
Section Cited
CCR
102402(a)(3)

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102402 Revocation or Suspension of a License or Registration (a) The Department shall have the authority to suspend or revoke any license for the following reasons: (3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility... 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 interview with Licensee, Licensee provided false statements to the investigator stating that she only uses a highchair for children under 1 year and is not currently using the highchair for any children, contrary to proof of text messages sent by Licensee to C1’s parent. This poses an immediate 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: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


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Document Has Been Signed on 10/04/2024 11:46 AM - It Cannot Be Edited


Created By: Farida Raja On 10/03/2024 at 10:17 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: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2024
Section Cited
CCR
102425(c)

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102425 Infant Safe Sleep (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.

This requirement is not met as evidenced by:
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Licensee to have authorized representative complete the form and submit proof to LPA by plan of correction date of 10/17/2024.
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During today's case management inspection, LPA reviewed infant's (C3) file and observed that child is missing the LIC 9227 form. LPA observed child placed to sleep on the stomach without signed LIC 9227 in file. This poses a potential health, safety or personal rights risk to persons 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: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


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