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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416768
Report Date: 09/01/2023
Date Signed: 09/01/2023 10:56:54 AM

Document Has Been Signed on 09/01/2023 10:56 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:NAKAMURA, MEGUMIFACILITY NUMBER:
434416768
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 9DATE:
09/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Megumi NakamuraTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Lopez conducted an unannounced Case Management- Licensee Initiated inspection. LPA met with Licensee Megumi Nakamura and explained the reason for the inspection. The purpose of this inspection is Licensee is applying for a large Family Child Care Home (FCCH). Licensee has been licensed since 5/2/22; therefore has at least a year of experience as a small FCCH operator to apply for a large FCCH. A fire clearance was granted on 8/21/23. Present during today's inspection were Licensee, 3 adult assistants, and 9 children (3 infants and 6 preschool age). Licensee was operating out of her licensing limits.

Licensee stated she thought she had already been approved for the increased capacity after the fire inspection was completed. LPA informed licensee that Licensing needs to conducts a visit, and it would still need to be reviewed and approved by management before she could operate a large FCCH. LPA informed licensee that the day care is still a small capacity and the maximum children is 8. LPA advised licensee that since she was over ratio (3 infants), she would need to contact one of the infants parents to come pick them up from the day care while the LPA was present. LPA informed licensee that the capacity/ratio violation would be a Type A citation.

LPA toured the home with Licensee. The off-limit area of the home is two bedrooms and the garage. LPA observed all disinfectants, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. LPA discussed with Licensee that anything that states to keep out of reach of children needs to be inaccessible. LPA reminded Licensee of the Safe Sleep regulations and that the door to where infants are sleeping needs to be open. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, in the home. There were no bodies of water observed during today's inspection.

------------------continues on 809 dated 9/1/2023 page 2---------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NAKAMURA, MEGUMI
FACILITY NUMBER: 434416768
VISIT DATE: 09/01/2023
NARRATIVE
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LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

When the Licensee has more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

Licensee 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, 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.

--------------continues on 809 dated 9/1/2023 page 3---------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
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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: NAKAMURA, MEGUMI
FACILITY NUMBER: 434416768
VISIT DATE: 09/01/2023
NARRATIVE
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As a result of todays inspection, there is a Type A deficiency issued.

LPA informed Megumi that this report dated, 9/1/2023 documents a Type A citation which shall be posted for 30 consecutive days as there are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated 9/1/2023 that documents Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Licensee Megumi Nakamura. A notice of site visit has been issued and must remain posted for 30 days.

Licensee will need to submit Proof of Correction for the Type A deficiency to licensing by due date. LPA informed licensee that this Type A citation may hinder her chances of management approving her application for a large Family Child Care Home. Licensee was informed that upon receipt of Licensing Management's approval, a license for a Large Family Child Care Home may be granted and issued to Licensee.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
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Document Has Been Signed on 09/01/2023 10:56 AM - It Cannot Be Edited


Created By: Ashley Lopez On 09/01/2023 at 10:00 AM
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: NAKAMURA, MEGUMI
FACILITY NUMBER: 434416768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2023
Section Cited
CCR
102416.5(b)(3)

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102416.5 Staffing Ratio and Capacity: (b) For a Small Family Child Care Home the maximum number of children for whom care may be provided... (3)More than six and up to eight children...only if the criteria in Section 1597.44 of the Health and Safety Code are met.
This requirement is not met as evidenced by:
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Licensee contacted parent of one infant and had them pick the child up while LPA was present. Licensee shall submit a written plan acknowledging understanding and complying with small family child care home ratio requirements at any given time within 24 hours by POC date 09/02/23.
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Based on observation, Licensee did not comply with section cited above. Licensee had 9 children(3 infants, 6 preschool) in care during inspection, which poses an immediate health and safety risk to children in care.
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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:Ashley Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2023


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