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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434410667
Report Date:
06/26/2023
Date Signed:
06/27/2023 09:36:10 AM
Document Has Been Signed on
06/27/2023 09:36 AM
- 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:
HAMEED, NAILA
FACILITY NUMBER:
434410667
ADMINISTRATOR:
HAMEED, NAILA & ABDUL
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 504-2270
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95135
CAPACITY:
14
CENSUS:
3
DATE:
06/26/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Naila Hameed
TIME COMPLETED:
02:15 PM
NARRATIVE
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On 06/26/2023 at 11am, Licensing Program Analyst (LPA), Farida Raja, arrived to conduct an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Naila Hameed and explained the nature of today’s inspection. Present in the home were licensee and three preschool children. Licensee was operating within the ratio and capacity requirements of her license. Days and hours of operation are Monday to Friday, 8:00 am to 6:00 pm. LPA observed all required posted materials,in the play area (converted garage) of the home. The adults that reside in the home are Licensee and Spouse. No minor children reside in the home. Licensee stated that she will email updated Emergency Disaster Plan to LPA.
LPA toured the indoor areas of the home during today's inspection. Licensee uses the converted garage for the daycare. Licensee does not use backyard or front yard for children in care. Licensee has a working telephone in the home (408-504-2270). LPA observed sufficient toys, books and play equipment for the day care children. Furniture, such as tables, chairs, and shelves, are in good condition. The floors were free of tripping hazards. The home has central heating/cooling and ventilation for comfort of children. The home is two story. In-use areas inside the home: converted garage as play room. Off limit areas outside the home: entire front yard and backyard. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free on any hazards.
LPA observed working smoke/carbon monoxide detectors. LPA did not observe a fire extinguisher. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee understands that smoking is prohibited in the home.
Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides lunch and two snacks to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated.
Continued on page 2
SUPERVISOR'S NAME:
Gladys Kuizon
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/20/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
06/27/2023 09:36 AM
- 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-DAY CARE
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
HAMEED, NAILA
FACILITY NUMBER:
434410667
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/26/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on record review the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Licensee is operating a daycare in the converted garage of the home. Based on record review of facility file a San Jose Fire Department Report dated 09/05/2008 states that garage is off limit for daycare use.
POC Due Date:
06/27/2023
Plan of Correction
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Licensee to submit Plan of Correction by due date of 06/27/2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
06/27/2023 09:36 AM
- 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-DAY CARE
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
HAMEED, NAILA
FACILITY NUMBER:
434410667
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/26/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee did not have a Fire Extinguisher in the home.
POC Due Date:
07/10/2023
Plan of Correction
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Licensee will purchase a fire extinguisher and send a picture of the fire extinguisher and receipt as proof of purchase by Plan of Correction date of 07/10/2023.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee, Naila Hameed, does not have a current Mandated Reporter Training.
POC Due Date:
07/10/2023
Plan of Correction
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3
4
Licensee will complete online training and send Certificate of Completion as proof by Plan of Correction date of 07/10/2023.
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
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
06/27/2023 09:36 AM
- 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-DAY CARE
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
HAMEED, NAILA
FACILITY NUMBER:
434410667
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/26/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee has completed an online Pediatric CPR/First Aid training on 06/22/2023 which is not accepted.
POC Due Date:
07/10/2023
Plan of Correction
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Licensee will send proof of EMSA certified in-person or hybrid Pediatric CPR/ First Aid training to LPA by Plan of Correction Date of 07/10/2023
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee does not have proof of MMR, Tdap and Influenza vaccinations on file.
POC Due Date:
07/10/2023
Plan of Correction
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Licensee will send proof of immunizations to LPA by Plan of Correction date of 07/10/2023.
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
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
Page:
4
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Document Has Been Signed on
06/27/2023 09:36 AM
- 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-DAY CARE
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
HAMEED, NAILA
FACILITY NUMBER:
434410667
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/26/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 3 children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/10/2023
Plan of Correction
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3
4
Licensee will submit proof of all required forms for three (3) children in care by Plan of Correction Date of 07/10/2023
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
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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:
HAMEED, NAILA
FACILITY NUMBER:
434410667
VISIT DATE:
06/26/2023
NARRATIVE
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LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 05/10/2023. LPA obtained copy of children's roster. Three (3) children's files were requested for review. Licensee did not have files for two children in care. Licensee states that she does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282).
LPA discussed the safe sleep regulations with licensee, including conducting 15-minute checks on all sleeping infants and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
as an additional resource. Licensee stated that she does not plan to care for infants. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at
https://www.cpsc.gov/
and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age.
Staff file review was completed. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee has completed an online Pediatric CPR/First Aid training on 06/22/2023 which is not accepted. Licensee will complete an EMSA certified in-person or hybrid Pediatric CPR/First Aid training and send proof to LPA. Licensee could not provide proof of immunization's for measles, pertussis and influenza Licensee has not completed the Mandated Reporter Training. LPA informed Licensee that the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website:
www.mandatedreporterca.com
for additional information on the online training. LPA reviewed facility records. Based on records, the San Jose Fire Department inspected the home on 09/05/2008 and noted in their report that the garage is off limit for day care use.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed
Continued on page 3
SUPERVISOR'S NAME:
Gladys Kuizon
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
Page:
6
of
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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:
HAMEED, NAILA
FACILITY NUMBER:
434410667
VISIT DATE:
06/26/2023
NARRATIVE
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Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.
LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.
Licensee is encouraged to visit the Department’s website at
https://cdss.ca.gov/inforesources/child-care-licensing
to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.
Licensee states that she does not administer any medications to the day care children at this time. This facility does not provide Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:
https://www.ada.gov/resources/child-care-centers/
.
The Licensee states that she does not transport children at this time. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.
Continued on page 4
SUPERVISOR'S NAME:
Gladys Kuizon
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
Page:
7
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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:
HAMEED, NAILA
FACILITY NUMBER:
434410667
VISIT DATE:
06/26/2023
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, Licensee, Naila Hameed, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
.
One (1) Type A and five (5) Type B violations were cited as a result of today's inspection.
Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were reviewed and discussed with Licensee, Naila Hameed. Citations are issued on 809-D pages of this report. Licensee signed the report acknowledging receipt of documents.
LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation
.
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.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME:
Gladys Kuizon
TELEPHONE:
(510) 566-5850
LICENSING EVALUATOR NAME:
Farida Raja
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2023
LIC809
(FAS) - (06/04)
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8
of
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