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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415761
Report Date: 06/04/2025
Date Signed: 06/05/2025 09:22:32 AM

Document Has Been Signed on 06/05/2025 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SHARMA, NANCYFACILITY NUMBER:
434415761
ADMINISTRATOR/
DIRECTOR:		SHARMA, NANCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 669-7670
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
06/04/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Nancy SharmaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced case management inspection as a result of an informal office meeting conducted with Licensee, Nancy Sharma on 01/16/2025. LPA met with Licensee, Nancy Sharma and explained the nature of today's inspection.

Upon arrival, LPA observed Licensee and assistant with 12 children including 2 infants and 10 preschool age. Licensee is operating within the ratio and capacity requirements of the license. All individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA reviewed children (C1-C12) and personnel records (S1). LPA observed that child, C5 is missing the immunization record and Personal Right's form (LIC 995A) and child, C10 is missing the Consent for Emergency Medical Treatment (LIC 627). LPA observed that all children have the LIC 9224 (Acknowledgement of Receipt of Licensing Reports) form in file but it does not specify the date of the Type A violation or office visit for which the report is shared. LPA informed Licensee that she is required to have three LIC 9224 forms for the inspections conducted on 08/20/2024, 12/09/2024 for which Type A violations were issued and one for the office visit conducted on 01/16/2025. Licensee stated that copies of all three reports were provided to parents but they did not return 3 forms as they were duplicate forms. LPA advised Licensee to explain the reason for sharing the reports and to include the dates on the LIC 9224 and clarify it for the parents receiving them. Licensee to have parents complete 3 LIC 9224's and submit the copies to LPA.

Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2025
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SHARMA, NANCY
FACILITY NUMBER: 434415761
VISIT DATE: 06/04/2025
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Upon review of 15-minute nap log for infants (C1 and C2) LPA observed pre-filled forms with child's names, staff initials, time of check conducted and nap position. For both infants, LPA observed that the nap checks for today and tomorrow were already pre-filled. Licensee stated that all children consistently nap at the same time everyday and if they wake up early Licensee crosses out the extra lines. LPA advised Licensee that nap logs need to be completed during the time of the check and cannot be completed prior to when the children go to sleep. LPA advised Licensee to indicate the name of the child, date, time of check and initials of person checking the child in real time and maintain that record for review. Licensee stated that she will do this going forward.

LPA observed that assistant, S2's file is complete with the required forms. Children's roster was observed to be complete.

LPA reviewed the ratio chart with Licensee and explained ages of children and ratio requirements with and without an assistant.

During today's inspection all children were observed to be sleeping on sleeping cots and no children were placed to sleep in a crib/play yard.

One Type B deficiency and one Technical violation was cited as a result of today's inspection. Appeal rights provided to Licensee.

Exit interview was conducted and report was reviewed with Licensee, Nancy Sharma.

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

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2025 09:22 AM - It Cannot Be Edited


Created By: Farida Raja On 06/04/2025 at 01:42 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: SHARMA, NANCY
FACILITY NUMBER: 434415761

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2025
Section Cited
CCR
102418(a)

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(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
This requirement is not met as evidenced by:
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Licensee to submit a written plan of correction along with missing immunization record and LIC 995 for one child (C5) to LPA by plan of correction due date of 07/02/2025.
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Based on observation, interview and record review, the licensee did not comply with the section cited above for one child (C5) which poses a potential health, safety or personal rights risk to persons in care.
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This is a repeat Type B violation. Civil penalty of $250 was issued.
Type B
07/02/2025
Section Cited
CCR102417(g)(7)

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(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
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Licensee to obtain Consent for Emergency Medical Treatment form (LIC 627) for one child (C10) and submit a written plan of correction along with the missing form to LPA by plan of correction due date of 07/02/2025.
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Based on observation, interview and record review, the licensee did not comply with the section cited above for one child (C10) which poses a potential health, safety or personal rights risk to persons in care. Child is missing the LIC 627- Consent for Emergency Medical Treatment form.
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This is a repeat Type B violation. Civil penalty of $250 was issued.
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: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2025


LIC809 (FAS) - (06/04)
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