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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412272
Report Date: 05/17/2023
Date Signed: 05/17/2023 10:33:38 AM


Document Has Been Signed on 05/17/2023 10:33 AM - 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:HAN, GUANGXUE & TANG, XIAOYANFACILITY NUMBER:
434412272
ADMINISTRATOR:GUANGXUE & XIAOYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 646-3186
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY:14CENSUS: 6DATE:
05/17/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Guanxue Han/Xiaoyan TangTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced Plan of Correction (POC) to the Facility today. LPA met with licensees Guanxue Han & Xiaoyan Tang, and explained the nature of today's visit to them. The purpose of the inspection is to review POCs for deficiencies that were cited on 05/04/2023. Present during today's inspection were licensees, 4 infants and 2 preschoolers.

The facility was issued a "Type A" deficiencies on 05/04/2023 for over ratio/capacity, and two "Type B" for outdated roster and missing some children's immunization records. The Plan of Correction was due on 05/13/2023.

Licensee submitted all the POCs and, a plan of correction statement to the office on 05/12/2023, prior to POC due date, LPA also observed that the Acknowledge of Receipt of Licensing Reports were signed by the parents of children in care and kept in each child's records. to the office on 5/12/2023. LPA observed the Notice of Site Visit, LIC 9099 & LIC 9099-D reports which were issued 05/04/2023 were posted on wall next to the facility entrance door.

LPA concludes that the the facility has completed its required plan of corrections and the deficiencies are thus cleared as of today's visit. LPA advised licensee, Guanxue Han that a schedule informal meeting may be held at the San Jose Regional office to discuss the deficiencies.

No deficiency was cited for this visit. A notice of site visit was given and must remain posted for 30 days. The report was discussed and verbally translated into Chinese during the exit interview with licensees, Guanxue Han & Xiaoyan Tang.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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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