434407129-6-12-2026-07-CC-FRAA-DUYQ4E-20260612115012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407129
Report Date: 06/12/2026
Date Signed: 06/12/2026 11:50:36 AM

Document Has Been Signed on 06/12/2026 11:50 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	TASHIRO, NARUMI		FACILITY NUMBER:	434407129
ADMINISTRATOR/ DIRECTOR:	TASHIRO, NARUMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 586-8711
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 4	DATE:	06/12/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Narumi Tashiro		TIME VISIT/ INSPECTION COMPLETED:	12:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 06/12/2026, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection. LPA was granted access to the home by Licensee, Narumi Tashiro and explained the nature of today’s inspection. Present in the home were licensee, daughter/assistant, Emily Tashiro and four children including two infants and two preschool children. Children continued to arrive during today's inspection. Licensee is operating within the ratio and capacity requirements of the license. Facility's current days and hours of operation are Monday to Friday, 7:30 am to 5:30 pm. LPA observed all required postings near the front entrance to the home. Three adults and no minor children 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. LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture was observed in good condition. The home has central heating/cooling and ventilation for comfort of children. The home is single story. Off limit areas inside the home: master bathroom, office, two bedrooms, laundry and attached garage. LPA observed two fireplaces one in the living and the other in the family room. Both fireplaces are barricaded with a glass cover. LPA observed that the child lock on the kitchen drawer with knives is broken. Licensee placed the knives in a higher location during the inspection and stated that the lock with be replaced. LPA observed one baby bouncer in the on limit living room that Licensee stated is not used by children. LPA reminded Licensee that baby bouncers are not allowed in family child care homes and need to be placed in an off limit area during operational hours. Off limit areas outside the home: storage shed. Backyard is fenced. LPA observed barricaded stairs outdoors from the deck to the lower grass level during today's inspection. Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 06/12/2026 11:50 AM - It Cannot Be Edited

Created By: Farida Raja On 06/12/2026 at 10:51 AM

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: TASHIRO, NARUMI	FACILITY NUMBER: 434407129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)(4)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (4) Mattresses shall be made specifically for the size crib or play yard in which they are placed. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above for two out of five play yards which poses a potential health, safety or personal rights risk to persons in care. Two out of three cribs were also obseved to be torn and LPA observed blankets covering the sides of some play yards and blankets inside some. No children were observed to be napping during the inspection.
	POC Due Date: 07/03/2026
	Plan of Correction
1 2 3 4	Licensee to submit picture proof of replaced play yard mattresses and torn cribs. Licensee to submit a detailed statement showing understanding of safe sleep regulations as a plan of correction to LPA by 07/03/2026.

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
1 2 3 4	Based on observation, interview and record reviewm the licensee did not comply with the section cited above for licensee and assistant which poses a potential health, safety or personal rights risk to persons in care. Licensee and assistant have not renewed the Mandated Reporter Training that expired on on 08/19/2025 and 10/17/2023 respectively.
	POC Due Date: 07/03/2026
	Plan of Correction
1 2 3 4	Licensee to submit certificate of comeplted Mandated Reporter Training for herself and assisant to LPA by 07/03/2026

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:

	Farida Raja
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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: TASHIRO, NARUMI	FACILITY NUMBER: 434407129
	VISIT DATE: 06/12/2026

NARRATIVE

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The outdoor space and play equipment were observed to be age appropriate and free of hazards. LPA reminded Licensee to scan the outdoor area for any hazards including toys in disrepair prior to allowing access to children. LPA reminded Licensee that water tables and wading pools need to be emptied immediately after use. There were no bodies of water observed during the inspection. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. LPA reminded Licensee to ensure that all disinfecting wipes and air fresheners are placed out of reach of children and all child locks are engaged to prevent access to off limit spaces by children.

LPA observed children's napping equipment. Licensee stated that older children (3 to 4 years old) nap in cribs in the living room and younger children nap in cribs in the master bedroom. Two out of three cribs in the living room were observed to be torn. Mattresses in two cribs, one in the living room and one in the bedroom were not specific to the size of the play yard and were much smaller. Licensee was advised to follow manufacturer recommendations on the ages of children allowed to nap in the play yard as well. LPA reminded Licensee that if the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. LPA observed blankets covering the sides of some play yards and blankets inside some play yards. No children were observed to be napping during the inspection. LPA reminded Licensee that cribs or play yards shall be free from all loose articles and objects and there shall be no objects hanging above or attached to the side of the crib. Licensee was advised to maintain a comfortable temperature in the home so children can nap without being covered. The mattresses in the crib or play yards must be firm and covered with a fitted sheet that is appropriate, fits tightly, and overlaps the underside of the mattresses.

LPA observed a 3A40 BC fire extinguisher in the hallway to the bathroom. LPA reminded Licensee that fire extinguishers need to be serviced annually and service tag or receipt of purchase maintained for review. Working smoke and carbon monoxide detector was observed in the living room. Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons and medications and other similar items were observed to be 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 she provides meals and snacks to the children in care. Parent have the option to provide meals as well. Food is provided by parents for infants.
Continued on Page 3

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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: TASHIRO, NARUMI	FACILITY NUMBER: 434407129
	VISIT DATE: 06/12/2026

NARRATIVE

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Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee states that a child will be isolated in the living room/ family room away from others if necessary due to illness or communicable disease.

LPA reviewed a current child care facility roster and fire/disaster drill log during today's inspection. Fire/disaster drill was last conducted on 12/19/2025. LPA informed Licensee that Fire Drills need to be conducted and documented every 6 months. LPA obtained copy of children's roster.

Four children’s files were reviewed during today's inspection. Licensee stated that she has liability insurance but was unable to provide proof of current policy. Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) was observed in some children's files. LPA advised Licensee to maintain a current policy verifying coverage or signed LIC 282 for all children in care. LPA reviewed two infant's file. Files were observed to include the Individual Infant Sleep Plan (LIC 9227) but the 15-minute sleep check has not been conducted since 05/01/2026. Assistant stated that it has been recorded on the phone but no log was maintained.
LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed staff (licensee and assistant) files for the required forms. Licensee and assistant have Pediatric CPR/First Aid certification which expires on 04/18/2028 but have not renewed the Mandated Reporter Training which expired on 08/19/2025 and 10/17/2023 respectively. Licensee was reminded that both the pediatric CPR/first aid and Mandated Reporter Training's needs to be renewed every two years. Licensee and assistant have the required immunization in file for measles and pertussis and were advised to maintain proof of influenza immunization's or statement declining the vaccine.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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: TASHIRO, NARUMI	FACILITY NUMBER: 434407129
	VISIT DATE: 06/12/2026

NARRATIVE

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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. LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty 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.

LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations Provider information Notices (PINs) and Quarterly Updates. LPA discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. Licensee states that no children require medications or IMS at this time. When any IMS is provided, 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Two Type B deficiencies and four technical violations were cited as a result of today's inspection. Appeal rights were provided.

Exit interview conducted and report was reviewed with Licensee, Narumi Tashiro. During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.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/inspection-process.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC809 (FAS) - (06/04)

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