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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409785
Report Date: 05/22/2025
Date Signed: 05/22/2025 01:24:36 PM

Document Has Been Signed on 05/22/2025 01:24 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SAINI, JASVINDERFACILITY NUMBER:
434409785
ADMINISTRATOR/
DIRECTOR:		SAINI, JASVINDERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 394-0904
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 8DATE:
05/22/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Saini, JasvinderTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kate Huang and Anna Morales conducted a Case Management inspection to follow up after an informal meeting conducted on 01/13/2025 at the San Jose Regional Office because of repeating Title 22 violations. LPAs was greeted by Jasvinder Saini. LPAs toured the facility, interviewed staff, and reviewed files.

LPAs observed 5 infants present at the facility including 1 grandchild (infant) of the licensee. Additionally, 3 preschoolers present including 1 grandchild of the licensee. Adults present included licensee, one helper and her daughter. Licensee stated that her daughter was traveling here. When LPAs arrived, LPAs observed that licensee and the helper were taking care of licensee’s two grandchildren. Licensee stated that one infant present was only a “trial period” infant. licensee explained that she was not a fully enrolled child, but parents wanted her to stay here for a couple of weeks to see whether she would be comfortable here before they decide to enroll. During the visit, LPAs called the parents of the “trial period” infant, the parents stated that their child has been here for one or two weeks, however, they are not sure of the exact start date.

LPAs reviewed staff’s records and observed licensee has current CPR and First Aid certifications which will expire in December 2025. Licensee also has current mandated reporter training certificate. Licensee and the helper have immunization records and required documents. LPAs observed a current roster of the children and 6 children’s files. Three newly enrolled children do not have LIC9224 (Acknowledgment of Receipt of Licensing Reports). LPAs reviewed the 15 minutes sleep check logs for all infants. They do have sleep check logs; however, the documents show that they did not check consistently with every 15 minutes, which is not meeting the Infant Safe Sleep requirements.

As a result of today’s inspection, three type B deficiencies were cited, see LIC809-D. Appeal rights provided to licensee. A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the licensee, Jasvinder Saini.
Gladys KuizonTELEPHONE: (510) 566-5850
Linke HuangTELEPHONE: (916) 917-6562
DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/22/2025 01:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SAINI, JASVINDER
FACILITY NUMBER: 434409785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
Section Cited
HSC
1596.8595(c)(2)

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1596.8595Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services (2) Upon enrollment of a new child in a facility, the licensee shall provide to the
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Licensee to submit plan of correction and signed LIC 9224 by the POC due date.
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parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period 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. This requirement is not met as evidenced by:
Based on file review, LPAs observed that 3 newly enrolled children(C3, C4 and C6) do not have LIC 9224 in flie which 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.
Gladys KuizonTELEPHONE: (510) 566-5850
Linke HuangTELEPHONE: (916) 917-6562

DATE: 05/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2025

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/22/2025 01:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SAINI, JASVINDER
FACILITY NUMBER: 434409785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
Section Cited
CCR
102425(j)(2)

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102425 INFANT SAFE SLEEP (j)The provider shall supervise infants while they are sleeping and adhere to the following requirements: (2) ...(D) Documentation shall be maintained in the infant’s file and be available to the Department for review.
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Licensee to submit a plan of corretion and new sleep check logs by the POC due date.
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Documentation shall include the following:a. Date.b. Infant’s name. c.Time of each 15-minute check.
This requirement is not met as evidenced by:
Based on dcoumentation, LPA's observed that the Licensee did not consistently check every 15 minutes for the four infants while sleeping, which poses a potential health, safety or personal rights risk to persons in care.
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An immediate civil penalty of $250 was assessed for repeating the same violation within 12 months.

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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.
Gladys KuizonTELEPHONE: (510) 566-5850
Linke HuangTELEPHONE: (916) 917-6562

DATE: 05/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2025

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/22/2025 01:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: SAINI, JASVINDER
FACILITY NUMBER: 434409785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
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, including children under age 10 who reside at the licensee's home and
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Licensee to provide a plan of correction to ensure that she remains in ratio at all times, by the POC due date.
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Based on observation, the licensee did not comply with the section cited above: LPA's observed LIcensee and one staff supervising a five(5)infants, upon entry to day care., which 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.
Gladys KuizonTELEPHONE: (510) 566-5850
Linke HuangTELEPHONE: (916) 917-6562

DATE: 05/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2025

LIC809 (FAS) - (06/04)
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