434413074-12-17-2019-07-CC-YHUG-BJXQXC-20191217113318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413074
Report Date: 12/17/2019
Date Signed: 12/17/2019 11:33:23 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:	CHANG, SUPIN		FACILITY NUMBER:	434413074
ADMINISTRATOR:	CHANG, SUPIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 391-5867
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 7	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Supin Chang		TIME COMPLETED:	11:50 AM

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) Oscar Huang met with Licensee Supin Chang for an unannounced annual/random inspection. LPA explained the nature of today’s inspection to Licensee. Present were two fingerpint clearance adult assistants, Yuan Wang & Yan Gu, and 7 day care children (3 infants & 4 preschool children) in the home during today's inspection. Days and hours of operation are Monday to Friday, 8:00am to 6:00pm. The adults that reside in the home are Licensee and her husband. Her two school age children are also live in home. LPA advised that her children will be accounted for the capacity when they present at home. 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. 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. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Temperature was measured at 70 degree F by thermostat on the wall. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. LPA observed fenced stairs inside the home. The main area of the home is used for the day care are living room, dinning room, and a bathroom. LPA observed a screened fireplace. 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 inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, at least working smoke detector, and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: entire second floor, kitchen, family room, and the garage. LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: both side yards. Licensee owns the house, and carries child care liability insurance with Westchester. Facility Evaluation Report dated 12/17/2019 to be continued on next page:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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, SUPIN	FACILITY NUMBER: 434413074
	VISIT DATE: 12/17/2019

NARRATIVE

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Facility Evaluation Report dated 03/07/2019 to be continued from previous page:
LPA observed Licensee and two assistants have current CPR and First Aid certification expiring 11/2021. LPA observed a current roster of the children. The last drills were conducted on 10/30/2019. LPA reviewed 8 children files. Immunization records are maintained and up-to-date. LPA observed Notification of Parents’ 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. LPA provided Licensee with the ratio/capacity chart for her reference. 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 reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed no appropriate records for immunization against measles, pertussis, and influenza for Licensee and the assistants 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.

LPA discussed Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training web site is available at: The training web site is available at: https://mandatedreporterca.com/, Licensee & her assistants request to be exempt from the training due to English is not their primary language.

No Deficiencies were cited. Exit interview conducted with Licensee. 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 Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

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