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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417018
Report Date: 08/06/2025
Date Signed: 08/06/2025 03:33:25 PM

Document Has Been Signed on 08/06/2025 03:33 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:		NADIA SAFIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 786-6924
CITY:EAST GARRISONSTATE: CAZIP CODE:
93933
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
08/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Nadia SafiTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Mandeep Kaur and Andy Yang conducted a unannounced Case Management inspection. LPAs met with Licensee, Nadia Safi and explained the purpose of today's inspection with them. Present were licensee's adult assistant(A1) and seven(7) children (3 infants & 4 preschool age)..

Upon arrival, at 12:45PM, LPAs observed two children(C1 & C2) in the car seats. Licensee states that the children(C1 & C2) were just dropped off at the facility at 12:30PM and they start their nap time at 12:30PM. LPAs observed child (C2) was taking a nap in a car seat and Child (C1) was next to Adult assistant (A1) on the floor in a car seat and Adult assistant (A1) was rocking the child (C1) in it. Adult assistant(A1) was sitting on a couch. LPA observed a child (C3), in the off limit area next to the kitchen and stairs, taking a nap in a electronic motion crib. Licensee states that child(C3) started at the facility on August 05, 2025 and parents of the child(C3) has a doctor note to use the electronic motion crib for the child (C3). Licensee states that parents of child (C3) have not provided the documents to the licensee where doctor has prescribed to use the electronic motion crib.

During today's inspection, LPAs observed that home is a two story home and the stairs, located in the kitchen area, is not fenced or barricaded while under five years old children are present in care. Licensee states that children are transitioned to the bathroom which is located in the kitchen area.

Licensee was advised of the infant safe sleep plan, personal rights of the children and Title 22 regulations requirements of operation of a Family Child Care home.

As a result of todays inspection, one Type A and two Type B deficiencies are issued on attached LIC809-D. Appeal rights provided.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/06/2025 03:33 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 08/06/2025 at 02:21 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: SAFI, NADIA
FACILITY NUMBER: 274417018

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2025
Section Cited
CCR
102423(a)(2)

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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 was not met as evidenced by:
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By plan of correction due date, 08/13/2025, Licensee will submit a written statement of understanding of Title 22 regulations requirements of children personal rights and If the child(C3) is still going to use the electronic motion crib with the doctor note, copy of the doctor's note, to the department. Licensee states that child(C3) may not attend the facility moving forward and licensee will include this statement in the plan of correction.
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Based on observations, child (C3) was in the offlimit area in a electronic motion Crib, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/20/2025
Section Cited
CCR102417(g)(3)

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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 be limited to:(3) Where children less than five years old are in care, stairs shall be fenced or barricaded.
This requirement was not met as evidenced by:
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By Plan of Correction due date, 08/20/25, Licensee will submit the proof of the fenced or barricaded stairs to the department. Licensee states that children are transitioned to the bathroom which is located in the kitchen area
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Based on observations, the stairs located in the kitchen area is not fenced or barricaded while under five years old children are present in care and children in care are transitioning through the kitchen area to the bathroom, which poses a potential health, safety or personal rights risk to persons in care.
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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.
Belinda Devall
NAME OF LICENSING PROGRAM MANAGER:
Mandeep Kaur
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2025 03:33 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 08/06/2025 at 02:34 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: SAFI, NADIA
FACILITY NUMBER: 274417018

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2025
Section Cited
CCR
102425(h)

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Infant Safe Sleep: (h)Car seats shall only be used for transportation purposes and shall not be used for sleeping.

This requirement was not met as evidenced by:
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By Plan of Correction due date, 08/07/2025, Licensee will submit the written statement of understanding of infant safe sleep to the department. Car seats were removed during today's inspection.
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Based on observations, upon arrival, two children (C1 & C2) were observed to be in the car seats in the living room. Child (C2) was taking a nap in a car seat and Child (C1) was next to Adult assistant (A1) on the floor in a car seat and Adult assistant (A1) was rocking the child (C1) in it, which poses an immediate risk to health, safety or personal rights risk to persons in care.
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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.
Belinda Devall
NAME OF LICENSING PROGRAM MANAGER:
Mandeep Kaur
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


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: 08/06/2025
NARRATIVE
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Exit interview conducted and report was reviewed with Licensee, Nadia Safi.

LPAs informed Licensee that this report dated 08/06/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Assembly bill 633 was provided and discussed with Licensee. LPAs informed the Licensee to provide a copy of this licensing report dated 08/06/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC809 (FAS) - (06/04)
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