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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417018
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:10:30 PM

Document Has Been Signed on 10/15/2024 04:10 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:SAFI, NADIAFACILITY NUMBER:
274417018
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On 10/15/24 at 3:10PM Licensing Program Analyst (LPA) Andrea Cortez conducted an unannounced case management inspection for capacity increase for large (14) home child care. LPA met with Nadia Safi. LPA interviewed Licensee, and toured facility.

Upon arrival LPA observed 6:1 ratio 3 infants and 3 preschoolers ages 2-5.

LPA toured the inside of the home during today's visit there is no backyard as the licensee will use the park across the street for outdoor playtime. LPA reviewed the Childcare Facility Roster and Fire/Disaster drill log during today's visit. LPA went over the importance of an updated roster with all current and former day care children. LPA reviewed six children's files and observed immunization records and the Family Childcare Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is orderly, and hazard free for day care children. LPA did not observe any wall heaters inside the home.



Off limit areas in the home: Garage, and Upstairs
On limit area: Living room, Kitchen, and Bathroom

Incidental Medical Services (IMS) policy was discussed. Applicant currently does not offer. When any IMS is provided, an updated Plan of Operation that includes IMS and submitted to the Department. LPA reviewed if the facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAFI, NADIA
FACILITY NUMBER: 274417018
VISIT DATE: 10/15/2024
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LPA observed a fully charged 3A40BC fire extinguisher, working smoke & carbon monoxide detectors, and no bodies of water. The Licensee states that there are no weapons or firearms in the home. All poisons/cleaners are inaccessible to children.

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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 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.

The licensee provided proof of control of property as the homeowner

Supervision of children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are always supervised. The Applicant understands her capacity ratios. The Applicant states that she does transport children. LPM gave capacity ratio chart for large family home child care for reference.

LPA reminded Licensee upon issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.


Applicant understands that the application for a large childcare license is pending Management and Fire District/Marshal approval.

No deficiency cited.

An exit interview was conducted. A copy of this report was discussed and left with the Licensee, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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