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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416723
Report Date: 06/26/2023
Date Signed: 06/26/2023 05:08:22 PM

Document Has Been Signed on 06/26/2023 05:08 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: 14DATE:
06/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Pooja SinghTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Licensee Pooja Singh and explained the reason for the inspection. The purpose of this inspection is to review the LIC 9224.

LPA reviewed 11 children's files during today's inspection. LPA observed that there were four (4) parent who did not sign the LIC 9224 by the next business day. LPA explained AB633 and that she is required to give a copy of the any reports that documents any Type A deficiencies to parents by the next business day or the next day that the child is present. LPA reviewed text message between Licensee and parents to confirm that parents received a copy of the report dated 05/17/2023 by the next business day, 05/18/2023.

No deficiencies were issued as a result of this inspection. Exit interview was conducted and report was reviewed with Licensee Pooja Singh. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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