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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417413
Report Date: 06/03/2024
Date Signed: 06/04/2024 08:19:11 AM

Document Has Been Signed on 06/04/2024 08:19 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KHAN, NEELOFARFACILITY NUMBER:
434417413
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
06/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Neelofar KhanTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 06/03/2024 at 8:44am, Licensing Program Analyst (LPA) Farida Raja conducted an announced, Pre-Licensing inspection in response to applicant/licensee, Neelofar Khan’s request for change in location and increase in capacity from a small to a large family childcare home (FCCH). Applicant currently has a small FCCH license #434416479 since 04/27/2021, and therefore is eligible to apply for a large FCCH. LPA explained the nature of today’s inspection to applicant. The adults that reside in the home are licensee, daughter and son. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances. Licensee has one minor child residing in the home. LPA reminded licensee that all children residing in the home under 10 years of age are counted in her capacity when present during operation hours. Fire Safety Clearance was granted on 05/31/2024 by the San Jose Fire Department . Present during the inspection were applicant/licensee, daughter, son, grandson and one preschool child.

Days and hours of operation will be Monday - Sunday from 7:00 AM- 6:00 PM. Applicant completed her Preventative Health and Safety Child Care Training on 12/19/2020 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 11/03/2024. Applicant has completed the Mandated Reporter Training for Child Care Workers on 08/23/2022. A copy of current TB test (applicant, son and daughter), MMR, Tdap and statement declining influenza vaccination for the Applicant are on file.

Applicant rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant states that she is planning to obtain daycare insurance once licensed.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHAN, NEELOFAR
FACILITY NUMBER: 434417413
VISIT DATE: 06/03/2024
NARRATIVE
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LPA toured the indoor and outdoor areas of the home with the applicant during today's inspection. The home is two story with 4 bedrooms and 3 bathrooms. LPA observed barricaded stairs leading to the second level. Off limit areas inside the home: kitchen, downstairs closet, laundry room, attached garage and entire second level. LPA inspected home for any health and safety hazards. Areas accessible to children were inspected to ensure that they are clean and orderly. There are sufficient toys, supplies, and equipment for the day care children. Applicant stated that the home has central heating and ventilation for comfort of children. Applicant stated that only the upper level of the home has air conditioning. LPA observed a barricaded fireplace in the on limit family room of the home. LPA observed the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. LPA reminded applicant that all shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover are to be made inaccessible to the children.

Off limit areas outside the home: right side section including gated section and locked storage area on the left side of the backyard. Backyard is fenced and gated. Applicant understands that children must be supervised at all times while outdoors. There are no bodies of water observed. Shade is provided outdoors by a sheet metal awning and LPA observed artificial grass to absorb falls.

Licensee has a working telephone in the home (408-791-7502). LPA observed a fully charged fire extinguisher (3A40BC) in the kitchen area and a working smoke and carbon monoxide detectors. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant states that she does not have any weapons/ammunition or pets in the home. Applicant stated that cleaning products, laundry detergents and similar toxic agents are placed in the garage. Knives and sharp objects were stored in high cabinets and made inaccessible to children. Applicant has a first aid kit in a child locked cabinet in the kitchen area. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Applicant currently has two cribs and one nap mat available for napping. Applicant stated that infants will nap in the on limit living room of the home. Applicant understands that high chairs are to be used only for eating purposes. Applicant states that no adults smoke and she understands that smoking is prohibited in the home.

Applicant states that parents will provide meals and snacks for the children. LPA reminded the Applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s).

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHAN, NEELOFAR
FACILITY NUMBER: 434417413
VISIT DATE: 06/03/2024
NARRATIVE
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Applicant stated that drinking water will be provided to children via individual water bottles and refilled using store bought water and LPA observed a store bought water dispenser in the kitchen. LPA advised applicant to have postings near the entrance so it is visible to parents/authorized representatives. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Form of discipline will be to talk to child to help them understand and calm down. Applicant stated that she will try to figure out the problem to help the child. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. Applicant stated that in case of a communicable disease child will be isolated in the dining area, away from the other children, until parent pick up.

LPA discussed the requirements of Assembly Bill(AB) 633 with the Applicant. Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.



LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHAN, NEELOFAR
FACILITY NUMBER: 434417413
VISIT DATE: 06/03/2024
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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant states that she will not provide transportation and LPA reminded applicant that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

Incidental Medical Services (IMS) policy was discussed. Applicant stated that she does not have any children that require Incidental Medical Services at this time. 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) or (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.

On this date, 05/31/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Applicant is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Licensing forms, Online option to pay Annual License fee, Adoption of Laws, etc

Exit interview conducted and report was reviewed with the Applicant, Neelofar Khan. LPA advised Applicant that a large Family Child Care Home License will be issued pending manager review and approval.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
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