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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403926
Report Date: 06/13/2023
Date Signed: 06/14/2023 09:21:28 AM

Document Has Been Signed on 06/14/2023 09:21 AM - 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HASSAN, SANJIDAFACILITY NUMBER:
434403926
ADMINISTRATOR:SANJIDA HASSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 274-6248
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Sanjida HassanTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Sanjida Hassan, and explained the nature of today’s inspection. Present in the home were Licensee, Licensee's Spouse/ Assistant and 6 children including 4 infants and 2 preschool age. Days and hours of operation are Monday to Friday, 7:00 am to 6:00 pm. LPA observed all required posted materials in the garage area of the home. Licensee operates the daycare in the converted garage of the home. The adults that reside in the home are Licensee and Spouse. Licensee has no minor children that reside in the home.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-274-6248). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs, feeding chairs, cubbies and cabinets are in good condition. The home has central heating/cooling and ventilation for comfort of children. The home is two story and LPA observed barricaded stairs near the entrance during today's inspection. In use areas of the home include: garage converted into play room, laundry room (diaper changing area) and bathroom located next to the laundry room. Off limit areas outside the home include: gated right side section and storage shed in the left side section of the yard. Licensee stated that she is planning to have the tan bark under the play structure replaced. LPA observed several bikes and chairs in the backyard that showed wear and tear. LIcensee stated that she plans to dispose them and placed them behind the right side gate while LPA was present. Backyard is fenced and no bodies of water were observed. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free on any hazards.

LPA observed a fully charged 3A40BC fire extinguisher in the garage area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. All

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HASSAN, SANJIDA
FACILITY NUMBER: 434403926
VISIT DATE: 06/13/2023
NARRATIVE
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detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee understands that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles. Licensee states that parents bring all meals for the day care children. LPA reminded Licensee that all food brought from home shall be labeled with each child's name and properly stored or refrigerated. LPA observed a refrigerator in the garage/play room.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 03/31/2023. LPA obtained copy of children's roster. Children file review was completed and found to be current and up to date. Six (6) children’s files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282).

LPA reviewed four infant children's files and one child is missing the Individual Infant Sleeping Plan (LIC 9227). LPA discussed the safe sleep regulations with Licensee, including documentation that shall be maintained and conducting 15-minute checks on all sleeping infants. LPA discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) and a sample 15- minute sleeping infant check form.

LPA reviewed two staff files (Licensee and one adult assistant). A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee and spouse have current Pediatric CPR/First Aid certification with an expiration date of 05/21/2025. Licensee and staff have the required vaccines (MMR, Tdap and influenza). Licensee's Mandated Reporter Training expires on 06/20/2023. Staff Mandated Reporter training is expired (06/09/2023). LPA reminded Licensee that the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HASSAN, SANJIDA
FACILITY NUMBER: 434403926
VISIT DATE: 06/13/2023
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.

Incidental Medical Services (IMS) policy was discussed. Licensee states that she does not administer any medications to the day care children at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HASSAN, SANJIDA
FACILITY NUMBER: 434403926
VISIT DATE: 06/13/2023
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The Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dess.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Three Type B deficiencies are being cited on the attached LIC 809D as a result of today's inspection.
Plan of Correction and Appeal Rights were discussed and provided to Licensee.

Exit interview conducted and report was reviewed with Licensee, Sanjida Hassan.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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Document Has Been Signed on 06/14/2023 09:21 AM - It Cannot Be Edited


Created By: Farida Raja On 06/13/2023 at 12:02 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: HASSAN, SANJIDA
FACILITY NUMBER: 434403926

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on record review, the licensee did not comply with the section cited above in 3 out of 4 children which poses a potential health, safety or personal rights risk to persons in care. Licensee did not conduct and record 15 minute sleep check on all infants in care.
POC Due Date: 06/27/2023
Plan of Correction
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Licensee will conduct 15 minute sleep checks on all infants in care and provide proof of checks to LPA by Plan of Correction date of 06/27/2023. Licensee was able to provide proof of checks while LPA was present. This deficiency is cleared.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in1 out of 2 which poses a potential health, safety or personal rights risk to persons in care. Licensee's Assistant/spouse did not have current Mandated Reporter Certification.
POC Due Date: 06/27/2023
Plan of Correction
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Licensee will have sssisstant complete the online Mandated Reporter Training and submit proof of complete training to LPA by Plan of Correction date of 06/27/2023
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/14/2023 09:21 AM - It Cannot Be Edited


Created By: Farida Raja On 06/13/2023 at 12:02 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: HASSAN, SANJIDA
FACILITY NUMBER: 434403926

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1 child which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2023
Plan of Correction
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Licensee will have parent complete form LIC 9227 for one infant in care and submit proof to LPA by Plan of Correction date of 06/27/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023


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