434414274-5-13-2026-07-CC-MKAR-DTZU4T-20260512151541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414274
Report Date: 05/12/2026
Date Signed: 05/13/2026 09:22:50 AM

Document Has Been Signed on 05/13/2026 09:22 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:	MASRI, FATIMA		FACILITY NUMBER:	434414274
ADMINISTRATOR/ DIRECTOR:	FATIMA MASRI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 477-9350
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 16	CENSUS: 12	DATE:	05/12/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:10 AM
MET WITH:	Fatima Masri		TIME VISIT/ INSPECTION COMPLETED:	03:25 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 05/12/2026, Licensing Program Analyst(LPA), Mandeep Kaur conducted an unannounced Annual/Random inspection. LPA met with Licensee, Fatima Masri and explained the reason for the inspection. Present during today's inspection were Licensee's assistant(S1)with twelve children(12 preschool age) and Licensee's spouse(A1). The hours of operation are Monday through Friday 08:00 AM to 5:00 PM. Licensee stated that a few enrolled children are part time and come to day care home on different days of the week. Licensee was advised that at any given time, Licensee shall operate within license capacity of the day care home. All required posting materials were posted. Licensee stated that Licensee and her spouse(A1) are the only adults residing in the home. LPA reviewed a copy of current children's roster during today's inspection. Fire/disaster drill was conducted on January 20, 2026. Licensee was reminded of fire drill to be conducted and documented every six (6) months. LPA observed a fully charged 2A10BC fire extinguisher, functioning smoke and carbon monoxide detectors, and glass covered fireplace. Licensee stated that there are no pets and no weapons or firearms in the home. LPA toured the inside and outside areas of the home with Licensee. Off limit areas in the home include the detached garage, downstairs master bedroom/bathroom, kitchen, Dinning room, living room, and entire upstairs. Offlimit areas outside the home are: shed and garden area next to the shed. Licensee use the swing area(in front of the shed in backyard) and the gated driveway(side yard of the home) for the children to play, outside of the home. There is a screened fire place in the living room. Licensee was advised that AC unit shall be covered at all times for children health and safety. Disinfectant and cleaning supplies were inaccessible to children. LPA reminded licensee that anything sharp or states to keep out of reach of children, such as blades or razors need to be inaccessible. There are age appropriate toys and equipment for children inside and outside of the home. There is no bodies of water observed during today's inspection. continue on next pages

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

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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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: MASRI, FATIMA	FACILITY NUMBER: 434414274
	VISIT DATE: 05/12/2026

NARRATIVE

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Licensee stated that children bring snacks and lunch from their own homes. Licensee was advised that the each child's water bottle, sippy cups or any food container that is brought from their homes, shall be labeled with the children names. Forms of discipline is talking to the children, redirecting the children with different activities and no corporal punishment. Licensee stated that isolated area for the sick child(ren) is in Day care Room 2 away from other children if needed for the children.

LPA reviewed eight(8) children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC 282) signed by the parents and Immunization Records.

LPA reviewed one staff file. Statement Acknowledging Requirement to Report Child Abuse,TB Clearance and Immunizations (Measles, Pertussis, and Influenza) and required training. LPA provided the Entrance checklist for Family Child Care home and discussed the immunizations and TB test requirements for the staff with Licensee. Licensee has immunizations in measles, pertussis and flu. Licensee has current Pediatric CPR/First Aid certifications with an expiration date of August 25, 2027. Licensee's Mandated Reporter Training was completed on August 27, 2025. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

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 also discussed that either licensee or an assistant needs to be present in the infant nap room during an infant is taking a nap.

**Continue on next page**

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

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: MASRI, FATIMA	FACILITY NUMBER: 434414274
	VISIT DATE: 05/12/2026

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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.

No Deficiency issued during today's inspection. Appeal rights were provided.

Exit interview conducted and report was reviewed with Licensee, Fatima Masri.

During the exit interview, the Licensee, Fatima Masri 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 ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

NAME OF LICENSING PROGRAM MANAGER: Mireya Flores
NAME OF LICENSING PROGRAM ANALYST: Mandeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC809 (FAS) - (06/04)

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