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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415761
Report Date: 12/09/2024
Date Signed: 12/09/2024 04:46:30 PM

Document Has Been Signed on 12/09/2024 04:46 PM - 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: 13DATE:
12/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:48 AM
MET WITH:Nancy SharmaTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On 12/09/2024 at 10:48am, Licensing Program Analyst (LPA) Farida Raja, arrived to conduct an unannounced case management inspection. LPA met with Licensee, Nancy Sharma and informed her of the purpose of today's inspection which is to ensure the facility is in compliance with Title 22 California Code of Regulations. Upon arrival, LPA observed a total of 12 children (6 infants and 6 preschool children) and one staff (licensee). Licensee stated that her assistant called in sick today. One more preschool child arrived during today's visit. Facility is over ratio and not in compliance with ratio requirements. This is a repeat violation in a 12 month period as the same violation was cited on 08/20/2024. LPA explained the ratio requirements of a large family child care home to licensee and provided Licensee with a copy of capacity handout. LPA informed Licensee that she cannot have more than 14 children in the home at any time (ratio and age of children to be observed) and a qualified assistant must be present. In the absence of a helper her license capacity is reduced to 8 and ratio and age of children must be observed.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed children using the family room and bathroom on the first floor. Licensee stated that children are not using the living room including the small office room as they had water leakage and are in the process of fixing it. LPA observed the child gate to the second level was not closed. LPA advised Licensee that stairs need to be barricaded at all times when children under 5 years of age are present. Licensee stated that children are not using the living room area at present so do not come on this side of the home.

LPA reviewed children's roster, children's files and one staff file. Children's roster is not current. This is a repeat violation in a 12 month period as the facility was cited for the same violation on 08/20/2024. Upon file review, LPA observed that children, C1, C2 and C15 are missing the Consent for Emergency Medical Treatment (LIC 627) and child C15 is missing the immunization record which are repeat violations in a 12 month period as the facility was cited for the same violations on 08/20/2024.

Licensee could not provide proof of 15 minute nap checks for 6 infants (C1, C2, C6, C7, C12 and C13) in care which is also a repeat violation.

Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
Document Has Been Signed on 12/09/2024 04:46 PM - It Cannot Be Edited


Created By: Farida Raja On 12/09/2024 at 01:17 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: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2024
Section Cited
CCR
102416.5(e)

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(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
This requirement is not met as evidenced by:
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Licensee to review regulations and submit a written plan of understanding to LPA by plan of correction due date of 12/10/2024.
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Based on observation and interview, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. Upon arrival, LPA observed a total of 12 children (6 infants and 6 preschool children) and one staff (licensee). Licensee stated that her assistant called in sick today. One more preschool child arrived during today's visit.
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This is a repeat Type A violation. Civil penalty of $250 was issued.

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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: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


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Document Has Been Signed on 12/09/2024 04:46 PM - It Cannot Be Edited


Created By: Farida Raja On 12/09/2024 at 01:21 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: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
102417(g)(8)

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(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
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Licensee to complete a current roster and submit to LPA by plan of correction date of 12/20/2024.
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Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Children's roster is not updated and current.
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This is a repeat Type B violation. Civil penalty of $250 was issued.
Type B
12/20/2024
Section Cited
CCR102425(j)(2)(D)(c)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check.

This requirement is not met as evidenced by:
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Licensee to review Safe Sleep regulations and conduct 15 minute nap checks on all sleeping infants. Licensee to submit proof of 15 minute check to LPA by plan of correction due date of 12/20/2024.
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Based on interview and record review, the licensee did not comply with the section cited above for six infants (C1, C2, C6, C7, C12 and C13) 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.
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: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 12/09/2024 04:46 PM - It Cannot Be Edited


Created By: Farida Raja On 12/09/2024 at 01:48 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: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
102417(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 three children (C1 and C2 and C15) and submit a written plan of correction along with the missing forms to LPA by plan of correction due date of 12/20/2024.
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Based on observation, interview and record review, the licensee did not comply with the section cited above for three children (C1 and C2 and C15) which poses a potential health, safety or personal rights risk to persons in care. All children are 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.
Type B
12/20/2024
Section Cited
CCR102418(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 for one child (C15) to LPA by plan of correction due date of 12/20/2024.
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Based on observation, interview and record review, the licensee did not comply with the section cited above for one child (C15) 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.
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: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2024 04:46 PM - It Cannot Be Edited


Created By: Farida Raja On 12/09/2024 at 01:55 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: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
HSC
1596.8595(c)(4)

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Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services (c) (4)The licensee shall keep verification of receipt in each child's file.
This requirement is not met as evidenced by:
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Licensee will submit missing LIC 9224 for seven children in care to CCLD by the plan of correction date of 12/20/2024.
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Based on observation and interview, the licensee did not comply with the section cited above. LPA observed that the Acknowledge of Receipt of Licensing Reports (LIC9224) has not been signed by the parent(s)/legal guardians of 7 children in care which poses a potential health, safety or personal rights risk to persons in care.
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Type B
12/20/2024
Section Cited
HSC1597.622(a)(1)

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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
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Licensee to submit missing staff immunizations to LPA by plan of correction date of 12/20/2024.
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Based on interview and record review, Licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee stated that the staff (S1) continues to be employed with Licensee but is sick today and was unable to come.
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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: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


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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: 12/09/2024
NARRATIVE
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LPA reviewed 14 children's files for the Acknowledgement of Receipt of Licensing Reports (LIC 9224) for the Type A violation cited on 08/20/2024. 7 out of 14 children's files reviewed did not have the signed LIC 9224 on file. LPA reminded Licensee that parents/guardians of all children currently enrolled needed to be provided a copy of the reported dated 08/20/2024 and the signed Acknowledgement needs to be maintained in children's files for verification.

Licensee stated that assistant (S1) continues to be employed with Licensee but is sick today and was unable to come. Upon review of assistant (S1) file, S1 is missing proof of immunization's for measles, pertussis and influenza.

One Type A and six type B deficiencies were cited as a result of today's inspection.

Civil penalties were issued for the repeat violation on the attached LIC 421FC pages. LPA Raja informed Nancy that this report dated 12/09/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Raja informed the licensee to provide a copy of this licensing report dated 12/09/2024 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal rights and LIC 9224 were printed and provided Licensee. Exit interview conducted and report was reviewed with Licensee, Nancy Sharma.

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

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC809 (FAS) - (06/04)
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