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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416723
Report Date: 08/13/2025
Date Signed: 08/20/2025 08:49:03 AM

Document Has Been Signed on 08/20/2025 08:49 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SINGH, POOJAFACILITY NUMBER:
434416723
ADMINISTRATOR/
DIRECTOR:		POOJA, SINGHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 442-8503
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:43 PM
MET WITH:Pooja SinghTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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On August 13, 2025, Licensing Program Analyst (LPA) Darnella Barnes conducted an unannounced Case Management visit to the licensed child care home in response to a referral regarding law enforcement presence at the residence. The purpose of the visit was to gather information related to the reported incident, assess the licensee’s compliance with Title 22 regulations, and ensure the continued health and safety of children in care.

Present during the visit were the licensee, seven daycare children, and the licensee’s two children, ages 9 and 11.

During the visit, LPA interviewed the licensee. The licensee stated that on August 7, 2025, at approximately 9:30 PM, an argument occurred between her husband, Davinderpal Singh, and her mother in the living room area. The argument escalated to the point where Davinderpal was observed with a handgun.

She reported that she was not aware of the presence of any firearms in the home prior to that night and immediately contacted law enforcement. Officers responded to the scene and removed the shotgun. The licensee reported that her brothers took the smaller firearm from the home.

The licensee confirmed that no daycare children were present during the August 7, 2025, incident. She stated that her husband no longer resides in the home and that there is no restraining order in place. She reported that both parties agreed to separate and that family members are actively involved in ensuring he does not return to the residence while children are in care.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
VISIT DATE: 08/13/2025
NARRATIVE
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When asked about the presence of firearms in the home, the licensee stated that during the most recent annual inspection on 8/8/25, she reported there were no weapons in the home because she was not aware of any at the time. She stated this was the first time she had seen any firearms in the residence.

The licensee confirmed that only she and her three children, ages 3, 10, and 11, currently live in the home. No other adults reside at the property. She stated she owns the home but was unable to provide a copy of the mortgage statement during the visit. She indicated the document is stored on a computer located upstairs and agreed to email it to LPA. .

When the licensee was asked about her reporting requirements, she stated that she did not consider the incident reportable because it did not occur during daycare operating hours, took place upstairs in an “off-limits” area, and no daycare children were present or affected. The licensee believed that, under those conditions, a report was not required. LPA explained that any law enforcement response to the licensed facility is an unusual incident and must be reported to the Department.



During today’s inspection, one Type B deficiency is issued on attached 809-D. A deficency B will be issued in accordance with Title 22, Section 102416.2(b)(3)(C) for failure to report any unusual incident.

The licensee was provided a copy of the applicable regulation and the LIC 624B Unusual Incident/Injury Report form for Family Child Care Homes to ensure understanding of reporting requirements and to assist with compliance in the future.

Appeal rights provided.

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

Exit interview conducted and report was reviewed with the Licensee, Pooja Singh

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/20/2025 08:49 AM - It Cannot Be Edited


Created By: Darnella Barnes On 08/13/2025 at 03:03 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: SINGH, POOJA
FACILITY NUMBER: 434416723

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2025
Section Cited
CCR
102416.2(b)(3)(C)

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102416.2(b)(3)(C) The licensee shall report to the Department any of the vents as speficied in Health and Safety Code 1597.467..that occur during the operation of the family child care home. (3)(C) Any unusual incident...that threatens the physical or emotional health and safety of any child
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The licensee shall provide a written plan outlining how she will ensure compliance with all reporting requirements moving forward by August 15, 2025 at 5:00pm to LPA email.
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This requirement was not met as evidenced by: Based on LPA's interview with licensee and reports received by the Department, licensee did not report a domestic altercation that occurred in the home on 8/7/25 involving firearms and local law enforcement's involvement. This posed a potential risk to the safety of the children.
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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.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Darnella Barnes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2025


LIC809 (FAS) - (06/04)
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