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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410869
Report Date: 01/31/2020
Date Signed: 01/31/2020 02:25:51 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:OU, LIDANFACILITY NUMBER:
434410869
ADMINISTRATOR:OU, LIDANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 366-2607
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 9DATE:
01/31/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Lidan OuTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Marilou Monico, conducted a case management inspection. Licensee attended a Non-compliance Conference at the San Jose Regional Office on October 24, 2019 for violation under Staffing Ratio and Capacity. LPA met with Licensee, Lidan Ou, and explained the purpose of the inspection. LPA toured the home. LPA observed nine napping preschool children in the family room. Also present were licensee's adult helper, Gayle Scott. LPA observed that the facility was in compliance with staff to children ratio/capacity requirement.

There were no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
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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