434412832-10-1-2021-07-CC-JCRZ-C6PTPV-20210909145458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412832
Report Date: 09/09/2021
Date Signed: 10/01/2021 09:00:10 AM

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:	ZHANG, GUIFEN		FACILITY NUMBER:	434412832
ADMINISTRATOR:	ZHANG, GUIFEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 218-4674
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	14	CENSUS:	DATE:	09/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:54 AM
MET WITH:	Guifen Zhang		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Janette Cruz met with Guifen Zhang, Licensee, for an unannounced Required – 1 year annual inspection. LPA explained the purpose of the visit and was granted access to the home by the Licensee. LPA also observed Licensee's spouse, Licensee's adult son and 3 children (2 infants and 1 preschool) in the home during today's inspection. The Licensee was operating within her capacity and ratio requirements during today's inspection. LPA observed that Licensee's son, Jason William Tews had already turned 18 years old on 05/15/2021 but Licensee states that her son has not yet obtained a criminal record clearance. LPA observed the required postings, including the facility license, located in the daycare playroom of the home. The home has a working telephone (408) 218-4674. Days and hours of operation are Monday - Friday from 8:00AM to 6:00PM. The Licensee, her spouse, Bruce Tews, and son, Jason Tews are the adults residing in the home. The Licensee's CPR and First Aid on file expires on 09/26/2023. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 06/22/21. The Licensee has the required vaccinations (MMR, Tdap, & flu). The Licensee’s Mandated Reporter Training for Child Care Workers on file expires on 11/29/2021. LPA reviewed three children's files and observed current and updated Identification and Emergency Information (LIC 700) and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee states that a child will be isolated in the living room area if needed to because of illness or communicable disease. LPA discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. REPORT CONTINUED ON FOLLOWING PAGE #2 - REPORT DATED 09/09/2021):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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: ZHANG, GUIFEN	FACILITY NUMBER: 434412832
	VISIT DATE: 09/09/2021

NARRATIVE

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LPA reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects.

LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly with heating and ventilation for safety and comfort of children. LPA observed a screened fireplace behind a children's cabinet that is not in use according to Licensee. Off limit areas inside the home: three bedrooms, barricaded kitchen and garage. Off limit areas outside the home: left side and right side of backyard that are gated and where AC condenser is located. The Licensee has no pets and no weapons in the home. LPA observed a fenced backyard. LPA observed no bodies of water.

LPA observed a fully charged 2A10BC fire extinguisher and working smoke/carbon monoxide detectors. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. LPA observed any poisons are locked in the attached garage inaccessible to the day care children.

A review of staff records on 09/09/21 indicates that not 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
REPORT CONTINUED ON FOLLOWING PAGE #3 - REPORT DATED 09/09/2021):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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: ZHANG, GUIFEN	FACILITY NUMBER: 434412832
	VISIT DATE: 09/09/2021

NARRATIVE

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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.

Supervision of children was discussed with the 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. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without a fully qualified adult present. The Licensee states that she does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA conducted an exit interview with the Licensee and advised a Type A deficiency is cited during today's inspection (See pages LIC809-D). Licensee agreed to have the following item/s submitted to LPA Cruz by Thursday, 09/23/21.
1. Copy of negative TB test for Licensee's adult son, Jason William Tews.

LPAs discussed the requirements of AB633 to Licensee and provided Licensee the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). Licensee understands the requirements. 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.

A Notice of Site Visit is issued and must be posted near the entrance to the home along with a copy of today's report for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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: ZHANG, GUIFEN	FACILITY NUMBER: 434412832
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/09/2021 Section Cited	1 2 3 4 5 6 7	102370 (d)(1) 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. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation, record reviews and interviews, Licensee's son, Jason Tews, did not obtain a criminal record and child abuse index clearance when he turned 18 years old. This poses an immediate threat to health and safety of children in care.	8 9 10 11 12 13 14	Civil penalty of $500 assessed today (see LIC 421BG). The Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months per the AB633 requirements.
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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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

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