434414215-6-16-2021-52-CC-MESA-C42Q7Z-20210616115559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414215
Report Date: 06/04/2021
Date Signed: 06/16/2021 11:56:06 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHAN, KAREN HIU		FACILITY NUMBER:	434414215
ADMINISTRATOR:	CHAN, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 594-8242
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 4	DATE:	06/04/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Karen Chan		TIME COMPLETED:	11:00 AM

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On 06/04/2021 at 8:55 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced required one (1) year visit. LPA met with the Licensee Karen Chan. Present on this visit were the Licensee's Assistant Anh Hoang and Licensee's spouse Yoon Lee, Licensee's own school age child and five (5) other preschool children in care. The home was toured to conduct a Health and Safety Inspection. The facility operates from Monday to Friday 8am to 6pm.

The home is a single family home. The home is neat and clean with heating and ventilation for safety and comfort. The on limit areas are the living room, hallway bathroom and the fenced backyard patio. The off limit area are the all bedrooms and the kitchen. The designated isolation area when a child becomes ill is the TV room. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. No firearms in the facility.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. Licensee does not transport children. The Licensee does not have a current CPR and 1st Aid and completed the Child Care Covid19 Attestation Form.

LPA reviewed chidlren's files.

LPA discussed and provided LIC 311D, PIN 21-08-CCLD, PIN 21-07-CCP, Guardian, Mandatory Directive from Santa Clara County Public Health, Santa Clara County Childcare Resource and Referral and Child Care Law Center contact information.

See LIC 809-C for continuation

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHAN, KAREN HIU	FACILITY NUMBER: 434414215
	VISIT DATE: 06/04/2021

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Individual Medical Services (IMS) policy was discussed. 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/childqanda.htm.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of her/his responsibility as mandated reporter.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee/director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

For licensing updates, advised Licensee to email childcareadvocatesprogram@dss.ca.gov and request to be added to the email list.

There are no deficiencies cited on this visit. This report shall remain on file for 3 years. A copy of the appeal rights was provided. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

LIC809 (FAS) - (06/04)

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