434410858-11-1-2023-07-CC-YHUG-CX6TF2-20231101144048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410858
Report Date: 11/01/2023
Date Signed: 11/01/2023 02:41:02 PM

Document Has Been Signed on 11/01/2023 02:41 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:	QU, WEI		FACILITY NUMBER:	434410858
ADMINISTRATOR:	QU, WEI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 265-6762
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 0	DATE:	11/01/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Wei Qu		TIME COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced case management inspection to the facility in regard to licensee requested to become active from inactive status. LPA met with licensee Wei Qu. LPA explained the nature of today’s inspection to Licensee. Present were licensee and her husband. LPA observed no other children at home. A review of staff records on 11/01/2023 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 changes to the facility as was active in the past. There are no stairs inside the home. Day care use area include the living room, dinning room, sun room, bedroom (baby room), and bathroom 1. Off limit areas inside the home: Rooms 1, the master bathroom, kitchen, attached garage. Off limit area outside the home: both side yards including a locked shed. LPA observed Licensee has current CPR and First Aid certification expiring 01/2024. LPA observed a fully charged 3A40BC fire extinguisher, a two working carbon monoxide detector on the wall in the hallway near to the front entry door, a working smoke detector at the ceiling in the living room, and fenced backyard.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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: QU, WEI	FACILITY NUMBER: 434410858
	VISIT DATE: 11/01/2023

NARRATIVE

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LPA observed sufficient materials, toys, and play 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. Temperature was measured at 71 degree F by thermostat on the wall. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee rents the house.

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.

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/.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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: QU, WEI	FACILITY NUMBER: 434410858
	VISIT DATE: 11/01/2023

NARRATIVE

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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.

No Deficiency was cited. Exit interview conducted with Licensee, Wei Qu and advised her that her license is now back to active status. 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.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

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