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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701361
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:30:35 PM

Document Has Been Signed on 04/18/2024 02:30 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:ACTION DAY NURSERYFACILITY NUMBER:
430701361
ADMINISTRATOR/
DIRECTOR:		BATE, STEPHANIEFACILITY TYPE:
850
ADDRESS:2146 LINCOLN AVENUETELEPHONE:
(408) 266-8952
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 154TOTAL ENROLLED CHILDREN: 222CENSUS: 126DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Lucy Nunez and Smriti DattaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mandeep Kaur conducted an Case Management inspection. LPA met with Site Supervisor, Lucy Nunez and Site Director, Smriti Datta. LPA toured the inside of the facility.

Based on observations, facility did not post the licensing reports provided by the department on 04/12/2024 immediately upon receipt, adjacent to the postings required pursuant to Section 1596.817 and on, or immediately adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days.

As a result of this inspection, Type B citation was issued. Civil Penalty Assessment LIC421CC was completed and signed during today's visit.

Exit interview conducted and report was reviewed with Site Director, Smriti Data. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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Document Has Been Signed on 04/18/2024 02:30 PM - It Cannot Be Edited


Created By: Mandeep Kaur On 04/18/2024 at 01:24 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: ACTION DAY NURSERY
FACILITY NUMBER: 430701361

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
HSC
1596.8595(a)(1)

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HSC 1596.8595(a)(1)(3)Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply;reports to be provided to parents or guardian of each child receiving services. This requirement was not met as evidenced by:
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Site Director immediately posted the Notice of Site Visit and Licensing reports with deficiency pages in the facility visible to parents. Civil penalty of $100 assessed during this visit.
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Based on observations, Notice of Site Visit and copy of licensing reports from 04/12/2024 were not posted in the facility which posed potential health, safety or personal rights risk to persons in care.
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Site Director will submit statement of
understanding of Posting of Licensing Report
Requirements as per HSC1596.8595 by POC
due date 04/19/23.

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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:Belinda Devall
LICENSING EVALUATOR NAME:Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024


LIC809 (FAS) - (06/04)
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