434416723-11-3-2023-07-CC-SYIP-CX8QCQ-20231103120327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416723
Report Date: 11/03/2023
Date Signed: 11/03/2023 12:03:33 PM

Document Has Been Signed on 11/03/2023 12:03 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, POOJA		FACILITY NUMBER:	434416723
ADMINISTRATOR:	POOJA, SINGH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 442-8503
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	11/03/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Pooja Singh		TIME COMPLETED:	11:55 AM

NARRATIVE

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Licensing Program Manager (LPM) Joel Segura and Licensing Program Analyst (LPA) Samantha Yip met with Licensee Pooja Singh for a scheduled Informal Meeting at the San Jose Regional Office. The purpose of this meeting was to discuss the recent citations. Licensee was cited on 05/17/2023 for criminal record clearance, staffing ratio and capacity, and safe sleep.

The citations are as followed:

102370(d)(1) Criminal Record Clearance. Licensee did not ensure that assistant had criminal record.

102370(d)(2) Criminal Record Clearance. Licensee allowed two assistants to work prior to her transferring their fingerprints to her facility roster.

102416.5(e) Staffing Ratio and Capacity. On 05/17/2023, LPA observed that Licensee’s assistant was alone with 9 children.

102416.5(b)(2) Staffing Ratio and Capacity. Licensee left her assistant alone with nine children. There were no other assistants present.

102425(b)(2) Infant Safe Sleep. Licensee’s child was in a crib that had bumper pads.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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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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: 11/03/2023

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----------------continuation of 809 dated 11/03/2023 page 1----------------------

Licensee submitted her plan of corrections to ensure that she is within ratio and capacity and understands the safe sleep regulations; along with that she needs to have any employees fingerprint prior to them started.

LPM discussed criminal record clearance, staffing ratio and capacity, and safe sleep with Licensee. A copy of the Consumer Product Safety Commission for Safe Sleep, FAQ for Safe Sleep, PIN 20-24-CCP, and Capacity Regulations was provided to Licensee during today's visit.

LPM Segura explained the informal meeting and the administrative process. Licensee was advised that continued non-compliance with Title 22 Regulations could result in their license being referred to CCL's legal department for review and possible action against the license. Assembly Bill 633 (Child Care Parent Notification Requirements) and Acknowledgement of Receipt of Licensing Reports (LIC9224) was also explained and provided to Licensee Pooja Singh.

Licensee understood that this department will increase monitoring of the facility for the next twelve months at the departments discretion.

Exit interview was conducted and report was reviewed with Licensee Pooja Singh.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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