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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412344
Report Date: 02/18/2020
Date Signed: 02/18/2020 04:25:49 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:CHANG, WEI-CHENFACILITY NUMBER:
434412344
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/18/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Wei-Chen ChangTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee, Weichen Chang for an unannounced inspection in response to licensee’s increase of capacity request. LPA explained the nature of today’s visit to Licensee. LPA observed 6 preschool children and a finger print assistant, Shaoying Chuang at home. Days and hours of operation are Monday to Friday, 9:00am to 6:00pm. The adults that reside in the home are Licensee and her husband.

A review of staff records on today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also 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. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, Licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care.

Licensee added an Accessory Dwelling Unit on their backyard, and plan to move her daycare to the entire ADU unit. The ADU includes two bedrooms, a kitchen, a bathroom, a living room, and a converted garage. There is no fireplace in the ADU. LPA toured the indoor for both the main house and ADU, as well as the outdoor areas of the home during today’s inspection. The entire home was inspected for health and safety hazards. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Temperature was measured at 68 degree F by thermostat on the wall. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored in top cabinets in the kitchen inaccessible to children. LPA observed ADU has a fully charged 2A10BC fire extinguisher, four working smoke detectors and three functioning carbon monoxide detectors. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: main house LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: left side yard.
Facility Evaluation Report dated 02/18/2020 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
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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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: CHANG, WEI-CHEN
FACILITY NUMBER: 434412344
VISIT DATE: 02/18/2020
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Facility Evaluation Report dated 02/18/2020 to be continued from previous page:

LPA observed Licensee has current CPR and First Aid certification expiring 05/2021. The adult assistant's CPR and First Aid certifications are current and expire on 05/2020. LPA observed a current roster of the children. The last drills were conducted on 07/15/2019. LPA reviewed 6 children files that are required by Title 22 regulations including Immunization records are maintained & up-to-date and Notification of parent rights is in each child's file.

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 for both small and large. LPA provided Licensee with ratio/capacity chart for her reference.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records for immunization against measles, pertussis, and influenza for Licensee and her helpers in file. Incidental Medical Services (IMS) were discussed with Licensee. Licensee is not providing IMS at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. on of Parents’ Rights is in each child’s file.

A fire safety inspection approval was received from Cupertino Fire Department on 02/10/2020 with the following details:
1. Test smoke alarms and carbon monoxide alarms monthly.
2. Maintain fire escape plan. Practice fire escape and keep log.
3. Inspect portable fire extinguisher monthly and service annually.
4. Maintain/test manual alarm bot and horn regularly.
5. Garage converted, no gas water heater or furnace, HVAC in space. exits approved. Approved conditionally with building permits. If the exiting, and heating & ventilation are removed, and the space is returned for use as a garage for automobiles, the large family daycare use will not be allowed by the fire department. Until then it is approved for daycare as far as fire safety requirements go.

No Deficiency was cited. Exit interview conducted with Licensee, and advised her that a large Family Child Care Home is now pending upon management approval.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
LIC809 (FAS) - (06/04)
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