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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409289
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:47:59 PM

Document Has Been Signed on 02/28/2024 02:47 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHAO, THERESAFACILITY NUMBER:
434409289
ADMINISTRATOR:CHAO, THERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 406-4261
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
02/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Theresa ChaoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced case management inspection to the facility in regard to licensee requested to modify her facility floor/yard plan by changing daycare activity area from ADU to main house which just completed an upgrade without changing the structure. LPA met with licensee Theresa Chao and explained the nature of today’s inspection to her. Present were licensee, her husband, a helper, and 3 preschoolers and 4 infants at home. Days and hours of operation are Monday to Friday, 8:30am to 6:00pm. The adults that reside in the home are licensee and her husband. Licensee submitted the new floor plan and yard plan sketches to the office and on file.
A review of staff records on 2/28/2024 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, 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 violate.
LPA toured the indoor and outdoor areas of the home during today’s inspection. The entire home was inspected for health and safety hazards. LPA observed no construction/structure changes to the facility. Day care use indoor areas will include two activity rooms (living room & family room), children sleeping (bedroom 1), and bathroom 1. Off limit areas inside the home: bedroom 2, master room, and bathroom 2, and kitchen. Outdoor play area includes patio area. Off limits area outdoor: right portion of backyard, two side years, and front yard.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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: CHAO, THERESA
FACILITY NUMBER: 434409289
VISIT DATE: 02/28/2024
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LPA observed Licensee & her helper have current CPR and First Aid certifications expiring 08/2025. LPA observed a fully charged 2A10BC fire extinguisher in the closet, each working 2-in-1 co/smoke detector on the wall in living room, children sleeping room, and hallway. A stand-alone co. detector on the wall in the family room.

LPA observed sufficient materials, toys, play equipment, and nap equipment for the day care children. The home is clean, orderly, and safe for the day care children. Licensee states that there are no weapons or pets in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded licensee that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed no screened open face wall heater. Temperature was measured at 70 degree F by thermostat on the wall. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee owns the house. A 12 gallon fish tank on top of the cabinet which is inaccessible to the children.

Supervision of children was discussed with Licensee, and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. Licensee states that she does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time.

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 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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: CHAO, THERESA
FACILITY NUMBER: 434409289
VISIT DATE: 02/28/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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 are available at: https://www.ada.gov/resources/child-care-centers/.

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.

During the exit interview, the licensee, Theresa Chao confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
No Deficiency was cited. Exit interview conducted with Licensee, Theresa Chao and advised her that the changes from an area of her family child care home previously identified as "off limits" to areas where care and supervision will be provided to children in care both indoor and outdoor are becoming effective as of today.

The report was discussed and verbally translated into Chinese during the exit interview with Licensee. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
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