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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416474
Report Date: 11/03/2023
Date Signed: 11/06/2023 09:36:52 AM

Document Has Been Signed on 11/06/2023 09:36 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:MOHAMMAD, SURIYAFACILITY NUMBER:
434416474
ADMINISTRATOR:SURIYA MOHAMMADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 457-4279
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
11/03/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Suriya MohammadTIME COMPLETED:
12:25 PM
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On 11/03/2023 at 8:45am, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Suriya Mohammad, and explained the nature of today’s inspection. The entrance to the facility is through the right side gate. Present in the home were licensee, two assistants (one assistant is licensee's mother) and seven children including three infants and 4 preschool age. Licensee was operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Sunday, 6:00 am to 6:00 pm. LPA observed all required posted materials near the kitchen area. LPA advised Licensee to have postings near the entrance so it is visible to parents/authorized representatives. Licensee stated that she will place the postings near the right side gate entrance. The adults that reside in the home are Licensee, mother and son. Licensee has no minor children residing 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 (408-457-4279). LPA observed sufficient materials, toys, and play equipment for the day care children. The home has central heating/cooling and ventilation for comfort of children. There are no stairs or fire places in the areas on limit to children in care. Off limit areas inside the home: living room, master bedroom, two bedrooms, laundry room, one bathroom, barricaded kitchen, dining room and attached garage. On limit areas include: family room, one bedroom and one bathroom. Off limit areas outside the home: gated left side section. The outdoor space and play equipment were observed to be age appropriate. Shade is provided by several canopies. There are no bodies of water observed. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free of any hazards.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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: MOHAMMAD, SURIYA
FACILITY NUMBER: 434416474
VISIT DATE: 11/03/2023
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LPA observed a fully charged 2A10BC fire extinguisher in the kitchen area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects 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 meals and snacks are provided by parents and by the licensee in case parents do not provide it. Licensee states that parents provide meals and snacks for all infant children. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee states that she provides meals and snacks to the children in care. Licensee uses communication and redirection with children as a form of discipline. Licensee states that a child will be isolated in the bedroom 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 10/07/2023. LPA obtained copy of children's roster.

Children file review was completed and found to be current and up to date. Six (6) children’s files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA reviewed three (3) infant's files and the files were complete with the required forms.

LPA discussed the safe sleep regulations with licensee, including conducting 15-minute checks on all sleeping infants 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 three (3) staff files (Licensee and two adult assistants) for the required forms. LPA confirmed through file review that the CPR/First Aid Training was up to date for each staff member present at the time of the inspection.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
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: MOHAMMAD, SURIYA
FACILITY NUMBER: 434416474
VISIT DATE: 11/03/2023
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A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee and staff have the required immunization in file for measles, pertussis and influenza/ statement declining influenza. Licensee's Mandated Reporter Training expires on 04/09/2025. Licensee's assistants did not have the Mandated Reporter Training since they are not fluent in English. LPA informed Licensee that if staff are not able to understand English they are exempt from completing the training at this time. Licensee understands the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

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.

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. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

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.

Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
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: MOHAMMAD, SURIYA
FACILITY NUMBER: 434416474
VISIT DATE: 11/03/2023
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Incidental Medical Services (IMS) policy was discussed. Licensee stated that she does not have any children that require medication at this time. 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/.

Licensees stated that they transport children. Licensee stated that they have a driver that transports school age children when needed. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. 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.

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.

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.

As a result of today's inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with the licensee, Suriya Mohammad.

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

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
LIC809 (FAS) - (06/04)
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