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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407309
Report Date: 09/27/2019
Date Signed: 09/27/2019 03:44:39 PM

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:YU, KARENFACILITY NUMBER:
434407309
ADMINISTRATOR:YU, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 781-3578
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:14CENSUS: 9DATE:
09/27/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Karen YuTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced Plan of Correction (POC) to the Facility today. LPA met with Licensee, Karen Yu, and explained the nature of today's visit to her. Present were two finger printed clearance assistants with 4 infants and 5 preschool children.

The facility was issued a "Type B" deficiency on Friday, September 06, 2019 for missing children records during an unannounced annual/random inspection on the same day. The Plan of Correction was due on Friday, September 20, 2019,

LPA observed all the children records that are required by Title 22 regulations are kept in each child's file. The facility was in compliance with the regulations. LPA concludes that the Licensee has completed his required plan of correction and the deficiency is thus cleared as of today's visit.

No deficiency was cited. Exit interview conducted with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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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