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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416723
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:02:07 PM

Document Has Been Signed on 10/27/2022 04:02 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SINGH, POOJAFACILITY NUMBER:
434416723
ADMINISTRATOR:POOJA, SINGHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 442-8503
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Pooja SinghTIME COMPLETED:
01:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Licensee Pooja Singh and explained the reason for the inspection. Upon arrival of today's inspection, Licensee, her spouse, her mom, who helps with the family child care home, and eight (8) children, whom 4 were infant age were present.

License and notification of parent's rights were observed to be posted. There is working phone in the home. The hours of operation are Monday through Friday 6AM to 6PM. Licensee carries liability insurance.

At 11:17AM, LPA heard Licensee speaking loudly at the children and telling them to clean up. LPA discussed with Licensee that children's personal rights cannot be violated and to be aware of her tone and volume of her voice.

LPA toured in the inside and outside of the home with Licensee. The off-limit areas of the home are the entire upstairs and garage. There are stairs in the home, which were barricaded. There is an electric fireplace in the home. Disinfectant and cleaning supplies were observed to be inaccessible to children. LPA reminded Licensee that disinfectant wipes, such as Clorax wipes, need to be inaccessible to children. There are toys and equipment for children, which were age-appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector in the home. The last disaster drill was conducted on 10/05/2022. Licensee stated that there are no weapons, such as firearms, stored in the home. Licensee does have a pet in the home.

---------------------continues on 809 dated 10/27/2022 page 2---------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
VISIT DATE: 10/27/2022
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------------------continuation of 809 dated 10/27/2022 page 1---------------------

The backyard is used and is fenced. LPA observed that there was a manual lawn mower in the backyard, which is accessible to children. Licensee moved lawn mower to the garage, which is off-limits. LPA also discussed with Licensee about ensuring that any poles or items are placed where it will not pose a safety risk to children in care. LPA reminded Licensee to ensure that any dog feces are picked up before children go outside. There were no bodies of water observed during today's inspection.

There is one play yard for infant. Licensee understands that infants need to have their own play yard and there cannot be anything in the crib and there cannot be anything attached to the pacifiers. Licensee stated that she does not document sleep logs. License started documenting times infants were checked during nap during today's inspection. 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. 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: http://www.ada.gov/childqanda.htm

-------------------continues on 809 dated 10/27/2022 page 3-----------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SINGH, POOJA
FACILITY NUMBER: 434416723
VISIT DATE: 10/27/2022
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A copy of the facility roster was obtained. Seven (7) children's files were reviewed during today's inspection. The records reviewed include but not limited to parent's rights and immunization records. LPA discussed with Licensee about ensuring all forms are filled out correctly and in its entirety.

Licensee and her mom's files were reviewed during today's inspection. The records reviewed include but not limited to Mandated Reporter training and immunization records. Licensee's mom completed the Mandated Reporter training on 09/14/2022. Licensee last completed the training on 05/10/2020. LPA discussed with Licensee that Mandated Reporter training requires renewal every two years. Licensee's mom did not have immunization record for measles.

The adults 18 and over living in the home are Licensee, her spouse, and her mother. Licensee also has three minor children. All adults have cleared fingerprints or exemption and TB clearance. 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.

LPA obtained an updated LIC 279 and LIC 279B during today's inspection.

Licensee will submit the following:
- LIC 995 for Ref-06
- Mandated Reporter training certificate for herself
- For her mom: immunization record for measles

As a result of this inspection, Type B deficiencies, technical violations, and a technical assistant were issued. Exit interview conducted and report was reviewed with Licensee Pooja Singh. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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Document Has Been Signed on 10/27/2022 04:02 PM - It Cannot Be Edited


Created By: Samantha Yip On 10/27/2022 at 12:56 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: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on 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. Licensee completed training on 05/10/2020.
POC Due Date: 12/12/2022
Plan of Correction
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By 12/12/2022, Licensee will complete training and send certificate to Licensing.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and record review, the licensee did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care. Licensee did not document the date, name of the child, and time checked.
POC Due Date: 11/04/2022
Plan of Correction
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Licensee will submit sleep log for 10/27/2022 for children. Licensee understands that Licensee or her assistant needs to physically check the children and document time checked.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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Document Has Been Signed on 10/27/2022 04:02 PM - It Cannot Be Edited


Created By: Samantha Yip On 10/27/2022 at 12:56 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: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102423(a)(4)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA heard Licensee telling children to clean up in a loud voice.
POC Due Date: 11/04/2022
Plan of Correction
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Licensee will submit plan on how she will ensure that children's personal rights are not violated.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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