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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414609
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:06:16 PM


Document Has Been Signed on 10/27/2022 02:06 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: 0DATE:
10/27/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kimeta & Adzija MetovicTIME COMPLETED:
02:10 PM
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Licensing Program Manager (LPM), Joel Segura, and Licensing Program Analyst (LPA), Marilou Monico, met with Licensees, Kimeta & Adzija Metovic, at the San Jose Regional Office today for a scheduled Informal Meeting. The purpose of today's meeting is to discuss the Licensees' compliance and ability to follow the Title 22 Regulations.

This Informal Meeting is a result of the following Type A violations:
09/07/22 - Section 102416.5(d)(1) - Staffing Ratio & Capacity - LPA observed two adult assistants present in the home with 10 daycare children including five (5) infants and five (5) preschool age.
06/14/22 - Section 102416.5(e) - Staffing Ratio and Capacity - Based on LPA's observation, Licensee's helper was alone in the home supervising seven (7) children including four (4) infants and three (3) preschool age.
05/25/18 - Section 102416.5(e) - Staffing Ratio and Capacity - LPAs Reed and Estapia observed licensee and helper with 12 children, six (6) of the children are under 2 years old. Civil penalty of $250 was assessed.
05/08/18 - Section 102416.5(e) - Staffing Ratio & Capacity - LPA Reed observed helper was alone with seven (7) children, three (3) of the children are under 2 years old.

LPM explained to Licensees that if there are continued deficiencies cited for the issues noted on this report, the Facility may be referred to legal department for possible administrative action, which could include revocation of the Facility license. The facility will be monitored for the next 12 months to ensure that the facility is in compliance with the department regulations.

Licensees agreed to maintain the required ratio and capacity at all times by either use a back-up staff, not accept a child/children that will result in being out of ratio, or not leaving the helper alone.



Assembly Bill 633 (Child Care Parent Notification Requirements) and Acknowledgement of Receipt of Licensing Report (LIC9224) was also explained and provided to Licensee during today’s meeting.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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