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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420595
Report Date: 06/25/2024
Date Signed: 06/25/2024 01:07:06 PM

Document Has Been Signed on 06/25/2024 01:07 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MISSION SAN JOSE CHILDREN'S HOUSEFACILITY NUMBER:
013420595
ADMINISTRATOR/
DIRECTOR:		CHIH MEI CHUOFACILITY TYPE:
850
ADDRESS:40065 MISSION BLVDTELEPHONE:
(510) 668-1277
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 10DATE:
06/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Chih Mei ChuoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On today's date, 6/25/2024 Licensing Program Analyst (LPA) Melanie Otsuji conducted an UNANNOUNCED ANNUAL/RANDOM. LPA met with Director, Chih Mei Chuo. The facility was toured to conduct a Health and Safety Inspection. Also present was 1 additional staff member and 10 preschool aged children. This program currently operates in 1 classroom Monday through Friday: 8AM - 6PM.

The preschool classroom was inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the presence of working carbon monoxide detector, smoke detectors/fire alarms and fully charged fire extinguishers that are accessible throughout the facility. There are no pools, hot tubs or other accessible bodies of water. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. Facility provides AM/PM snacks and lunch to children in care or they can bring their lunch from home. Children bring their own water bottles from home which are refilled with filtered water from water service. LPA observed the preschool play yard and observed, tarps and building overhang for shade. No hazards were observed on the play yard on today's date. LPA reviewed a sample of staff files and children files.

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MISSION SAN JOSE CHILDREN'S HOUSE
FACILITY NUMBER: 013420595
VISIT DATE: 06/25/2024
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA referred facility representative to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

LPA discussed the safe sleep regulations with facility representative 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 facility representative 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.

This facility provides Incidental Medical Services – IMS. However, at this time no children require any IMS.
For IMS information see PIN 22-02-CCP. 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 IMS. Facility representative 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.

No citations are noted on today's date.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Chih Mei Chuo.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
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