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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411314
Report Date: 06/06/2019
Date Signed: 06/06/2019 12:10:55 PM

COMPREHENSIVE INSPECTION
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:TANG, FLORENCEFACILITY NUMBER:
434411314
ADMINISTRATOR:TANG, FLORENCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 730-5266
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 12DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Florence TangTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marilou Monico, made an annual random inspection. Present in the home were licensee, licensee's adult helper, and 12 preschool age children. Days and hours of operation are Monday to Friday from 8:30 AM to 1:30 PM. There are three adults living in the home: licensee, her husband, and her son.

LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and safe. The home has 3A40BC fire extinguisher. There is a working smoke and carbon monoxide detector, barricaded fireplace and stairs, and no bodies of water. Off limit areas in the home: entire upstairs, one bedroom downstairs, and garage. Off limit areas outside the home: both side sections of the home. Medications, cleaning compounds, sharp objects are stored out of reach of children. Per licensee, there are no weapons in the home. Twelve children's files and a helper's file were reviewed. Licensee maintains a current children's roster and fire drill log. LPA obtained copy of children's roster. Licensee and her helper have current CPR/First Aid certifications with an expiration date of August 14, 2020.

LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. LPA reviewed and provided licensee with lead information sheets and advised her to provide copies to parents.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/06/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TANG, FLORENCE
FACILITY NUMBER: 434411314
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2019
Section Cited
CCR
102370(d)(1)
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CRIMINAL RECORD CLEARANCE - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee states that she will have her son obtain fingerprint clearance as soon as possible and will submit a written plan of correction by 06/07/19.
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This requirement is not met as evidenced by: LPA learned that licensee's adult son, Joshua Yu, is residing in the home without fingerprint clearance. This poses an immediate risk to the health and safety to children in care.

Civil penalty of $500.00 was assessed.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TANG, FLORENCE
FACILITY NUMBER: 434411314
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2019
Section Cited
HSC
1596.8662(b)(1)
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MANDATED REPORTER TRAINING - On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee states she will submit proof of completion for her and her helper by 07/15/19.
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This requirement is not met as evidenced by: LPA observed that licensee and her helper have not completed the Mandated Reporter Training. This poses a potential risk to Health, Safety to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TANG, FLORENCE
FACILITY NUMBER: 434411314
VISIT DATE: 06/06/2019
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/06/19):

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemption with the exception of licensee's son, Joshua Yu. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

As a result of this inspection, deficiencies were cited on the following pages:

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: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4