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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416723
Report Date: 05/17/2023
Date Signed: 05/17/2023 05:43:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2023 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230512121641
FACILITY NAME:SINGH, POOJAFACILITY NUMBER:
434416723
ADMINISTRATOR:POOJA, SINGHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 442-8503
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 11DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Pooja Singh TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee is operating out of ratio.
Licensee is operating over capacity.
Licensee allowed provider to work prior to obtaining a criminal record clearance.
Licensee did not ensure infant’s sleeping area is free from all loose articles and objects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegations. LPA arrived at the home at 1:35PM. Licensee arrived at the home at 1:43PM with two of her own children. LPA entered the home at 1:43PM.

During the course of this investigation, LPA inspected the home and conducted interview with Licensee. Based on the information obtained, the above allegations are found to be SUBSTANTIATED, meaning the preponderance of the evidence standard has been met.

-------------------continues on 9099 dated 05/17/2023 page 2--------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 07-CC-20230512121641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
VISIT DATE: 05/17/2023
NARRATIVE
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-----------------continuation of 9099 dated 05/17/2023 page 1------------------------

Upon entrance of the home, LPA observed that there was only one adult with nine (9) children, whom two were infant age while Licensee went to pick up her children. The facility was not in compliance with ratio and capacity. LPA discussed with Licensee staffing and ratio to Licensee. LPA provided Licensee a copy of 102416.5: Staffing Ratio and Capacity to Licensee during today's inspection and a breakdown of the capacity/ratio.

A-1 was present at the home and hired as an assistant. A-1 does not have cleared fingerprints or associated to the facility. A-1 started working at the facility today, 05/17/2023. Licensee stated that she will have A-1 obtained fingerprints and will not have A-1 returned until her fingerprints are cleared and associated. Licensee also stated that A-2 and A-3 worked at her assistant. A-2 has cleared fingerprints, but fingerprints were not transferred to her facility. A-2 worked from 05/08/2023 to 05/10/2023. A-3 worked only on 05/15/2023 and does not have cleared fingerprints. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Upon arrival of the home, children were napping. LPA observed that Licensee's infant age child was sleeping in a crib, which had bumper around it and a mobile hanging above the crib. LPA discussed with Licensee that there cannot be anything around the crib or attached to the crib. 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.

------------------continuation of 9099 dated 05/17/2023 page 3-----------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 07-CC-20230512121641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
VISIT DATE: 05/17/2023
NARRATIVE
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----------------continuation of 9099 dated 05/17/2023 page 2------------------------

As a result of this inspection, four type A citations were issued. A civil penalty of $500 was assess for caregiver background check. Exit interview conducted and report was reviewed with Licensee Pooja Singh. A notice of site visit has been issued and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Samantha Yip informed licensee Pooja Singh that this report dated 05/17/2023 documents four (4) Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the licensee Pooja Singh to provide a copy of this licensing report dated 05/17/2023 that documents any Type A citations 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 07-CC-20230512121641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2023
Section Cited
CCR
102416.5(e)
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Staffing Ratio and Capacity. 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 as evidenced by:
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By 05/18/2023, Licensee will submit a written plan on how she will ensure that she is within capacity at all time and if she needs to leave the
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Based on observation, Licensee left A-1 alone with nine (9) children, whom two (2) were infant age, which poses an immediate risk to the health and safety to children in care.
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home.
Type A
05/18/2023
Section Cited
CCR
102416.5(b)(2)
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For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: Six children, no more than three of whom may be infants...
This requirement is not met as evidenced by:
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By POC 05/18/2023, Licensee will submit written plan on she will ensure she is within ratio at all time.
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Based on observation, Licensee left her assistant alone with nine (9) children, which poses an immediate health and safety risk to children in care.
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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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 07-CC-20230512121641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2023
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department...
This requirement is not met as evidenced by:
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By POC 05/18/2023, Licensee will not have A-1 return until her fingerprints are cleared and associated to her facility roster.
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Based on observation, interview, and record review, A-1 was present and helping with the children during today's inspection. A-3 worked on 05/15/2023. A-1 and A-3 does not have cleared fingerprints. This poses an immediate risk to the health and safety to children in care.
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Type A
05/18/2023
Section Cited
CCR
102370(d)(2)
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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 102370(j)...
This requirement is not as evidenced by:
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Deficiency is corrected. A-2 is no longer working at the FCCH.
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Based on interview, A-2 worked at the facility from 05/08/2023 to 05/10/2023. A-2 has cleared fingerprints, but fingerprints were not transferred, which poses an immediate risk to the health and safety to children in care.
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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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 07-CC-20230512121641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2023
Section Cited
CCR
102425(b)(2)
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Infant Safe Sleep. Cribs or play yards shall be free from all loose articles and objects. Bumper pads shall not be used.
This requirement is not met as evidenced by:
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By POC 05/24/2023, Licensee will submit written plan on she will ensure that there is no bumper pad used in the crib and that she
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Based on observation, LPA observed that Licensee's child who is infant age was in a crib that had bumper pads, which poses a potential risk to children in care.
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understands the infant safe sleep regulation.
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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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7