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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414609
Report Date: 09/07/2022
Date Signed: 09/07/2022 03:26:20 PM


Document Has Been Signed on 09/07/2022 03:26 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:METOVIC, KIMETA & ADZIJAFACILITY NUMBER:
434414609
ADMINISTRATOR:KIMETA & ADZIJAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 355-3687
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:14CENSUS: 10DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Envera Krajnic & Kimeta MetovicTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico made an unannounced Case Management Inspection. LPA met with Licensee's adult assistant, Envera Krajnic, and explained the nature of today's inspection. Also present in the home were adult assistant, Emina Omerhodzic, and 10 daycare children including five (5) infants and five (5) preschool age. Licensees, Kimeta and Adzija Metovic, arrived during the inspection. LPA met with Licensee, Kimeta Metovic.

LPA obtained a copy of children's roster.

As a result of this inspection, deficiency was cited on the following page:

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 09/07/2022 03:26 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: METOVIC, KIMETA & ADZIJA
FACILITY NUMBER: 434414609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2022
Section Cited

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Staffing Ratio and Capacity - 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 the assistant provider's children under age 10, shall be: (1) Twelve children, no more than four of whom may be infants.
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This requirement is not met as evidenced by:
LPA observed two adult assistants present in the home with 10 daycare children including five (5 ) infants and five (5) preschool age. This poses an immediate risk to the health, safety, and personal rights of children in care.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 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.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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