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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410399
Report Date: 01/24/2023
Date Signed: 01/24/2023 09:48:28 AM

Document Has Been Signed on 01/24/2023 09:48 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:KRAJA, ALJBANAFACILITY NUMBER:
434410399
ADMINISTRATOR:KRAJA, ALJBANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 379-9401
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/24/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kraja, AljbanaTIME COMPLETED:
09:55 PM
NARRATIVE
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On 1/24/2023 at 9:00AM Licensing Program Analysts (LPAs) Pete Hernandez, and Farida Raja and Licensing Program Manager (LPM) Gladys Kuizon met with Licensee Aljbana Kraja for an Informal Meeting. The pre-scheduled meeting took place at the San Jose Regional Licensing Office.

On 11/01/2022 at 2:00 pm, LPA conducted an unannounced facility visit and observed 9 children in care. The licensee and 2 assistants (S1-S2) were present. LPA arrived during nap time and observed 2 children sleeping in car seats.

On 11/3/2022, LPA conducted another unannounced visit and observed 8 children in care Based on records: children’s files and children's roster, 6 children were under the age of 2.

As a result, the facility was cited 2 Type A deficiencies and 2 Type B deficiencies in November 2022.

The purpose of the informal meeting is to review the deficiencies with the Licensee and discuss the plan of corrections submitted by the licensee to ensure licensee’s understanding of Title 22 violations that led to the deficiencies.

LPM Gladys Kuizon explained the informal meeting and the administrative process. Licensee was advised that continued non-compliance with Title 22 Regulations could result in their license being referred to Community Care Licensing's legal department for review and possible action against the license. Child Care Parent Notification Requirements (LIC 995) and Acknowledgement of Receipt of Licensing Reports (LIC9224) was also explained and provided to Licensee during today’s meeting.
Continued on page 2 of the report dated 1/24/2023
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KRAJA, ALJBANA
FACILITY NUMBER: 434410399
VISIT DATE: 01/24/2023
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During the meeting, the Licensee was reminded that since there was an issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted in the facility and a copy must be given to all parents of current 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.

Licensee understands that the facility will be placed under increased monitoring for the next 12 month to ensure compliance with Title 22 regulations.

LPA provided visual aids to the Licensee: 1) List of file documentation required for the adults living in the home and required documents for each employee. 2) LPA also provided the staffing and capacity ratio visual chart to the licensee.

LPM provided the provider resources on www.cdss.ca.gov. Licensee signed up for provider updates.

This report was discussed with and a copy provided to Aljbana Kraja.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC809 (FAS) - (06/04)
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