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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416155
Report Date: 04/15/2025
Date Signed: 04/15/2025 04:03:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
04/10/2025 and conducted by Evaluator Syeda Bahar
COMPLAINT CONTROL NUMBER: 07-CC-20250410083647
FACILITY NAME:CARASTAN, MEHRNAZFACILITY NUMBER:
434416155
ADMINISTRATOR:MEHRNAZ CARASTANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 705-0505
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:14CENSUS: 5DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mehrnaz CarastanTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Licensee failed to notify parents of Type A violations and non-compliance conference.
INVESTIGATION FINDINGS:
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On 04/15/2025 at 1:30 p.m., Licensing Program Analysts (LPAs), Syeda Bahar and Mandeep Kaur, conducted an unannounced complaint investigation. LPAs met with Licensee, Mehrnaz Carastan and discussed the complaint allegation with them, LPAs toured indoor areas of the facility. Upon arrival, present were licensee and one assistant(S1) with five children including one infant and four preschool age children.

Later, Licensee's assistant (S2) joined during the investigation.

LPAs reviewed eight(8) children files for verification of LIC 9224(Acknowledgement of Receipt of Licensing Reports) in each child's file. LPAs reviewed three(3) staff files. LPAs observed that the Acknowledgment of Receipt of Licensing Reports (LIC 9224) were not signed by the parents of eight (8) children out of eight children in care and kept in each child's records.

**Continue on page 2**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Syeda Bahar
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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 5
Control Number 07-CC-20250410083647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155
VISIT DATE: 04/15/2025
NARRATIVE
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**Page 2**

LPAs interviewed licensee during today's investigation. Licensee self admitted that she does not have signed LIC9224(Acknowledgement of receipt of licensing reports) form by the parents of enrolled children or any child enrolled after 10/03/2024 for Type A citation that was issued on 10/03/2024. Licensee stated that she had provided LIC 9224 forms to the parents, but was not aware of keeping LIC 9224 in each children file. Licensee stated that she will collect the signed LIC 9224 from parents of all enrolled children and any child, who will enroll 12 months from the date of 10/03/2024, Type A citation issued date.

Based on interviews and records review during the investigation process, the Department concludes that facility has not provided the licensing reports to parents for Type A citation, that was issued on 10/03/0224, per AB633 requirements. Therefore, the above allegation is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

AB633 requirements were provided and discussed with Licensee.

As a result of this investigation, Type B deficiency was cited on the following page: 9099-D. Appeal rights provided.

Exit interview conducted, report was reviewed with the licensee,Mehrnaz Carastan.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Syeda Bahar
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 07-CC-20250410083647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CARASTAN, MEHRNAZ
FACILITY NUMBER: 434416155
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2025
Section Cited
HSC
1596.8595(c)(1-4)
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HSC 1596.8595((c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.(2) Upon enrollment of a new child in a facility...(3)recipient to sign(4)keep verification of receipt on child's file...This requirement was not met as evidenced by:
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By plan of correction due date 04/22/2025, Licensee will submit the written statement of understanding of health and safety section code: 1596.8595(c)(1-4), to provide the copies of the report of Type A citations issued on 10/03/2024 by licensing and keep signed LIC9224, Acknowledgement of Receipt of Licensing Reports by the parents of enrolled children and next 12 months of any enrolled child in each children file per AB633 requirements,
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Based on interviews and records review, licensee did not obtained, signed LIC9224, Acknowledgement of Receipt of Licensing Reports, by parents for Type A citation, that was issued on 10/03/2024, per AB633 requirements, which poses a potential health, safety or personal rights risk to persons in care.
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Licensee will submit the copy of LIC 9224, Acknowledgement of Receipt of Licensing Reports to the department for eight currently enrolled children.
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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: Belinda Devall
LICENSING EVALUATOR NAME: Syeda Bahar
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5