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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416529
Report Date: 01/13/2025
Date Signed: 01/13/2025 03:20:00 PM

Document Has Been Signed on 01/13/2025 03:20 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PAROL, JASMINEFACILITY NUMBER:
434416529
ADMINISTRATOR/
DIRECTOR:		JASMINE PAROLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 500-4616
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
01/13/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Shaan ParoleTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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At 12:30 PM, Licensing Program Analyst (LPA) Andy Yang was greeted by Son (staff S1) to conduct an unannounced annual random inspection. Present for this inspection were (2) Staff (S1 and S2) and 11 Children (3 infants and 8 preschool age). Son stated that the licensee was not available as she had to attend to an emergency, therefore she was not present for the inspection. The inspection will be conducted with Staff S1. The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday to Friday 8:00 AM to 6:00 PM. The ages of children to be served is from 12 months to 12 years old.

The home is two story single family home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are great room, dining room, kitchen, den, bathroom, garage, and backyard. The OFF LIMIT AREAS is the entire second floor are inaccessible by closed and/or locked doors and visual supervision. There is a barricade installed at the bottom of the stairs. The ISOLATION AREA is den. The outdoor play area is free from defects or dangerous conditions and is fenced. LPA observed no fireplace and no open face heaters in the home. There have been no changes from the areas previously identified as OFF LIMITS or alterations to existing building or grounds. There are ample age-appropriate toys that appear to be safe and in good condition. There are no bodies of water. All hazardous materials and toxins are kept out of the reach of children. Staff S1 states that any poisons are stored in cabinets that are inaccessible and locked to children and/or second floor which is OFF LIMITS. LPA reminded the staff that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes.


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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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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: PAROL, JASMINE
FACILITY NUMBER: 434416529
VISIT DATE: 01/13/2025
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The home has a fully charged (2) 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The Licensee CPR and First Aid certificate is current and expires 6/30/2026. Licensee completed the Mandated Reporter Training for Child Care Providers on 7/06/2022 (expired on 7/2024) and a copy of the certification is on file. Staff S1 was reminded of Mandated Reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the licensee’s immunization is on file. Per Staff S1, there are no firearms in the home. The Staff stated that licensee conducts and documents fire and disaster drills every 2 months. Per Staff, the last drill was conducted in January 2025. Personnel records are available for review and contain all required forms. Child’s records are available for review and contain all required forms. All REQUIRED forms are posted and visible for public review.

LPA observed that there were no 15 minute sleep check log in file for the (2) infants over 12 months of age. Staff S1 stated that they have not been documenting 15 minute checks for the infants. LPA reminded the Staff S1 that providers must check on sleeping infants every 15 minutes and document their conditions to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness. LPA provided a copy of Safe Sleep Regulation PIN 20-24-CCP.

Forms of discipline to be used by Staff S1 are redirecting and talking with the child. Staff understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature.

Also, discussed with the Staff S1 was isolation of sick children, supervision of children, staffing ratio and capacity, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
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: PAROL, JASMINE
FACILITY NUMBER: 434416529
VISIT DATE: 01/13/2025
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Staff S1 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.

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-andresources/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.

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/.

Staff S1 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.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
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: PAROL, JASMINE
FACILITY NUMBER: 434416529
VISIT DATE: 01/13/2025
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During the exit interview, the Staff S1, Shaan Parol, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 12/31/2024.

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.

During today’s inspection, one “Type B” deficiency and two Technical Violations are issued on attached 809-D. Appeal rights provided.
  • Type B for missing documentation of the infant 15 minute sleep log for Child C3
  • Technical Violation for licensee's expired Mandated Reporter training
  • Technical Violation for licensee's temporary absence exceeding 20% of the hours the facility is providing care per day

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Staff S1, Shaan Parol
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/13/2025 03:20 PM - It Cannot Be Edited


Created By: Andy Yang On 01/13/2025 at 02:27 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: PAROL, JASMINE
FACILITY NUMBER: 434416529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review of infant file for Child C3 there were no documentation of infant 15 minute check log the which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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By POC due date of 1/17/2025, Licensee will provide copy of infant 15 minute check log for child C3.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Belinda Devall
LICENSING EVALUATOR NAME:Andy Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2025


LIC809 (FAS) - (06/04)
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