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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417473
Report Date: 05/14/2026
Date Signed: 05/14/2026 12:37:07 PM

Document Has Been Signed on 05/14/2026 12:37 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VAID, GWENDOLYNFACILITY NUMBER:
434417473
ADMINISTRATOR/
DIRECTOR:		GWENDOLYN VAIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 403-7877
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
05/14/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Gwendolyn VaidTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 05/14/2026, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection. LPA was granted access to the home by Licensee, Gwendolyn Vaid and explained the nature of today’s inspection. Present in the home were Licensee, Assistant (S1) and nine children including one infant, six preschool children and two school age children. Children continued to arrive during today's inspection. Licensee is operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:30 AM to 5:30 PM. LPA observed all required posted materials and a weekly curriculum plan near the front entrance to the home. Four adults and eight minor children reside in the home. Licensee submitted an updated Current Children in the Home (LIC 279B) form during today's inspection. Licensee to submit an updated Application for a Family Child Home License (LIC 279) to LPA by 05/29/2026. LPA provided Licensee with a copy of the Entrance Checklist (LIC 126) during today's inspection. LPA provided the annual fee notice to Licensee.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture was observed in good condition. The home has central heating/cooling and ventilation for comfort of children. The home is single story with four bedrooms and three bathrooms. Off limit areas inside the home include three bedrooms, three bathrooms, kitchen, two offices and detached garage. LPA observed a child gate in the hallway barricading the off limit rooms and two barricading the kitchen area. Fireplace in the on limit family room was observed to be covered.

LPA observed a 2A10BC fire extinguisher that was last serviced on 03/10/2025 and working smoke and carbon monoxide detector. LPA reminded licensee that the fire extinguisher needs to be serviced once every 12 months and service tag or proof of purchase maintained for review.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2026
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: VAID, GWENDOLYN
FACILITY NUMBER: 434417473
VISIT DATE: 05/14/2026
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Licensee states that she does not have any weapons in the home. Licensee has some chickens in the outdoor area. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. Licensee understands that smoking is prohibited in the home. Bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free of hazards.

The outdoor space and play equipment were observed to be age appropriate and free of hazards. Backyard is fenced and the sides of the home are gated. There are no bodies of water observed. There are no off limit areas outdoors. Licensee stated that children play in the front area right outside the family room. Children are accompanied by licensee or assistant when they go to the garden area or towards the chicken coop.

Drinking water is readily available for children in the home via individually labelled water bottles. Licensee states that she provides meals and snacks to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated.

Licensee stated that a child will be isolated in the living room if necessary due to illness or communicable disease. LPA reviewed a children's roster and a fire/disaster log during today's inspection. The roster was not updated. Licensee stated that the last fire drill was conducted in 08/2025 but the last fire drill was logged on 11/05/2024. LPA reminded Licensee that fire drills need to be conducted atleast once every 6 months and documented for review.

Six random children’s files were reviewed during today's inspection. Licensee carries daycare insurance and LPA observed a current policy. LPA reviewed two infant's files and the files were complete with the required forms including nap logs. LPA reminded Licensee that when using an application to record the nap checks Licensee needs to maintain record of checks conducted every 15 minutes and not just the beginning and end time of the nap. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age during today's inspection. Children C1 and C3 were observed to be missing the immunization record. Also, LPA reminded Licensee to request and maintain proof of updated immunization records from authorized representatives and a signed copy of the Additional Children in Care form (LIC 9150) in each child's file.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VAID, GWENDOLYN
FACILITY NUMBER: 434417473
VISIT DATE: 05/14/2026
NARRATIVE
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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 and removing any 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.

Licensee and assistant's files were reviewed. All facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee has current Pediatric CPR/First Aid certification which expires on 3/28/2028. Licensee's Mandated Reporter Training expires on 12/15/2026. Licensee understands the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. Assistant was observed to be missing proof of immunization's for measles, pertussis and influenza and proof of negative tuberculosis test.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.


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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: VAID, GWENDOLYN
FACILITY NUMBER: 434417473
VISIT DATE: 05/14/2026
NARRATIVE
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Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing which will provide access to resources such as forms, regulations Provider Information Notices (PINs), and Quarterly Updates. LPA discussed Reporting Requirements as outlines in the regulations (Section 102416.2)

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. Licensee states that no children requires medications or IMS at this time. LPA provided Licensee with a copy of PIN 22-02-CCP during today's inspection. 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: https://www.ada.gov/resources/child-care-centers/

Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Four Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Licensee. Exit interview conducted and report was reviewed with Licensee, Gwendolyn Vaid. During the exit interview, Licensee, Gwendolyn Vaid confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

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 https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 05/14/2026 12:37 PM - It Cannot Be Edited


Created By: Farida Raja On 05/14/2026 at 12:07 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: VAID, GWENDOLYN
FACILITY NUMBER: 434417473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and 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 stated that the last fire drill was conducted in 08/2025 but the last fire drill was logged on 11/05/2024. LPA reminded Licensee that fire drills need to be conducted atleast once every 6 months and documented for review.
POC Due Date: 05/29/2026
Plan of Correction
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Licensee to submit a written plan of correction to LPA by plan of correction due date of 05/29/2026.

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:
Farida Raja
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2026


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 05/14/2026 12:37 PM - It Cannot Be Edited


Created By: Farida Raja On 05/14/2026 at 12:07 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: VAID, GWENDOLYN
FACILITY NUMBER: 434417473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for assistant, S1 which poses a potential health, safety or personal rights risk to persons in care. Assistant was observed to be missing proof of immunization's for measles, pertussis and influenza and proof of negative tuberculosis test.
POC Due Date: 05/29/2026
Plan of Correction
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Licensee to submit proof of missing immunizations and tuberculosis test for S1 to LPA by plan of correction due date of 05/29/2026.
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for two children (C1 and C3) which poses a potential health, safety or personal rights risk to persons in care. LPA also reminded Licensee to request and maintain proof of updated immunization records from authorized representatives and a signed copy of the Additional Children in Care form (LIC 9150) in each child's file.
POC Due Date: 05/29/2026
Plan of Correction
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Licensee to submit proof of missing documents to LPA by plan of correction due date of 05/29/2026.
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:
Farida Raja
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/14/2026 12:37 PM - It Cannot Be Edited


Created By: Farida Raja On 05/14/2026 at 12:07 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: VAID, GWENDOLYN
FACILITY NUMBER: 434417473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and 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. The children's roster was not updated.
POC Due Date: 05/29/2026
Plan of Correction
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2
3
4
Licensee to submit an updated roster and a written plan of correction to LPA by plan of correction due date of 05/29/2026.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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2
3
4
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:
Farida Raja
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2026


LIC809 (FAS) - (06/04)
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