434411722-12-30-2022-07-CC-AMOS-CMLMJU-20221230083940

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411722
Report Date: 12/29/2022
Date Signed: 12/30/2022 08:39:51 AM

Document Has Been Signed on 12/30/2022 08:39 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:	KAUR, NAVDEEP & SINGH, KARNAIL		FACILITY NUMBER:	434411722
ADMINISTRATOR:	KAUR, NAVDEEP & SINGH, KAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 615-0643
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	12/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Navdeep Kaur		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Anna Morales conducted an Annual Required visit and was greeted by Licensee Navdeep Kaur and her staff. Licensee stated that her husband Karnail Kaur, sons Jasonjit Singh, Arshdeep Singh, daughter in law Ravina Patel reside at the home. LPA observed a total of eight children: three under 24 months of age(over 12 months) and five pre-school aged children. The day care is located in the back of the house. Parents enter from the side of the house. The front part of the home is off limits from the day care. The front portion of the house is a two story and there are stairs. LPA reminded Licensee to barricade the stairs while children are present. Days and hours of operation are Monday - Friday from 8:00 AM to 6:00 PM. LPA reviewed Fire/Disaster drill log during today's inspection. Last Fire/Disaster Drill was conducted on 7/15/2022. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA recommended Licensee to secure a book case that is the corner (under the television). Licensee stated that she will consider relocating the book shelf or replacing it with another item of furniture. The backyard is enclosed by a fence. Off limit areas inside Licensee's home: (upstairs): 3 bedrooms, 2 bathrooms, and prayer room. (downstairs): master bedroom, master bathroom, 1 bedroom, 1 bathroom, 2 hallway closets, laundry room, and attached garage. Off limit areas outside the home: front yard, 1/2 left side area of the backyard, 1 locked shed in the backyard, and 1 storage cabinet in the backyard.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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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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: KAUR, NAVDEEP & SINGH, KARNAIL	FACILITY NUMBER: 434411722
	VISIT DATE: 12/29/2022

NARRATIVE

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Licensees are exempt from the Mandated Reporter Training (AB1207) as English is not their primary language. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed atwww.mandatedreporterca.com.

Four of the children’s files were reviewed during todays inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM286).

Licensees and staff files was reviewed for the following records: Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). S2 does not have immunization record on file. Licensees do have current First Aid/CPR on file ( It expires on 5/2023).

LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12- month period.

Incidental Medical Services (IMS) policy was discussed. Licensees stated that they do not take care of children who are ill. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Licensee have an area where sick children can be isolated from the others until parent pick-up.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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: KAUR, NAVDEEP & SINGH, KARNAIL	FACILITY NUMBER: 434411722
	VISIT DATE: 12/29/2022

NARRATIVE

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LPA discussed the requirements of AB 633 with the Licensee and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). 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. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Exit Interview was conducted with Licensee. Deficiencies are being cited based on the LPA's observations, interviews conducted and records reviewed in accordance with the California Code of Regulations Title 22.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

DUE TO TECHNICAL DIFFICULTIES, LPA WAS UNABLE TO PRINT A COPY OF THIS REPORT.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/30/2022 08:39 AM - It Cannot Be Edited

Created By: Anna Morales On 12/29/2022 at 03:03 PM

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: KAUR, NAVDEEP & SINGH, KARNAIL	FACILITY NUMBER: 434411722
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above. LPA was unable to review S1 immunization record, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/30/2023
	Plan of Correction
1 2 3 4	Licensee will submit a copy of S1 immunization record to CCL by the POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 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

LICENSING EVALUATOR NAME:

Anna Morales

LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC809 (FAS) - (06/04)

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