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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412802
Report Date: 10/23/2023
Date Signed: 10/24/2023 03:51:24 PM


Document Has Been Signed on 10/24/2023 03:51 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:YAN, MINFACILITY NUMBER:
434412802
ADMINISTRATOR:YAN, MINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 228-7482
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:14CENSUS: 4DATE:
10/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Min YanTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Sheena Chin met with Licensee, Min Yan, for an unannounced annual inspection. LPA explained the nature of today’s inspection to Licensee. Present during today’s inspection were the licensee, Min Yan, her husband, Bo Luo and 4 kids in care in the facility. Days and hours of operation are Monday to Friday, 8am to 6:30pm. The adults that reside in the home are licensee and her husband. The licensee owns the home.

Observation
LPA observed that required postings were posted. LPA, along with the licensee toured the inside and outside of the home. The facility has a full charged fire extinguisher, 3A40BC. Carbon monoxide and smoke detectors are working properly. The off-limit areas inside in the facility are 3 bedrooms, kitchen, garage, front yard and the storage room in the back yard. All disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA observed that there are toys for children and the food brought from home was labeled with the child’s name.
LPA conducted CARE Tools for this annual inspection, which include Physical Plant, Care and Supervision, Facility Administration, Records, Staffing Ratio and Capacity, Personnel Rights for compliance with all licensing statutes, regulations, and interim licensing Standards, and results were documented on the tool.

Records review
The Licensee & her husband have current CPR and First Aid certifications expiring 10/23/2024, and the child abuse training certificate, expiring 1/1/2025. LPA reviewed the fire and disaster drills log which is to be done at least once every six months. The last drills were conducted on 10/18/2023.

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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: YAN, MIN
FACILITY NUMBER: 434412802
VISIT DATE: 10/23/2023
NARRATIVE
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Records review
LPA reviewed files for all children, who are between 2 to 3 years old. Immunization records are maintained and updated. LPA observed Notification of Parents’ Rights is in each child’s file..
A review of staff records on 10/05/2023 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Discussion


Supervision of children was discussed with Licensee, who 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, a Plan for Providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: YAN, MIN
FACILITY NUMBER: 434412802
VISIT DATE: 10/23/2023
NARRATIVE
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Discussions
The Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Deficiency
No deficiency was cited.

Further questions
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Exit
During the exit interview, the Licensee, Min Yan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted and report was reviewed in Mandarin with the Licensee, Min Yan.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3