434414645-6-3-2024-07-CC-SCHN-D5VVAM-20240603161610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414645
Report Date: 06/03/2024
Date Signed: 06/03/2024 04:16:25 PM

Document Has Been Signed on 06/03/2024 04:16 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:	WU, JUAN		FACILITY NUMBER:	434414645
ADMINISTRATOR:	WU, JUAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 649-6477
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	14	CENSUS: 12	DATE:	06/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Juan Wu		TIME COMPLETED:	04:30 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	Page 1. On 6/3/24 around 1:25pm Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced annual inspection at the facility. The licensee, Juan Wu, was not in the facility. Around 2pm the licensee returned to the facility. LPA met the licensee and explained the nature of today’s inspection. LPA advised the licensee that per regulation 102417(a) … temporary absences shall not exceed 20 percent of the hours that the facility is providing day care per day. Present during today’s inspection were the licensee, 3 helpers and 12 children in the facility. Days and hours of operation are Monday to Friday, 8:30am to 6:00pm. The adults that reside in the home are the licensee, and her husband. The licensee stated she owned 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, 2A10BC. Carbon monoxide and smoke detectors are working properly. The off-limit areas inside in the home are all the bedrooms, kitchen, garage, storage rooms in the back yard, patio off the kitchen and side 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 inside and outside of the house. 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. continue to page 2.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WU, JUAN	FACILITY NUMBER: 434414645
	VISIT DATE: 06/03/2024

NARRATIVE

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Records review
The Licensee did not have current CPR and First Aid certifications expiring 3/21/24. The licensee stated that she has scheduled a CPR/First Aid training on 6/22/24. One of the helpers, S3, had a valid CPR/First Aid certification expiring 6/10/25 The Licensee has the child abuse training certificate, expiring 5/16/26. 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 2/15/24. LPA reviewed helpers and children’s files. Immunization records are maintained. LPA observed Notification of Parents’ Rights is in each child’s file, and 15 min. Immunization records and employee rights were observed in the helper’s file. S1 was hired on 4/10/24. LPA advised the licensee to have S1 finish Mandated Reporter Training within 90 days after the employment date.

During today’s inspection, all adults present or residing in the home have criminal record clearances required by the Department. 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 violat

Discussion

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.

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.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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: WU, JUAN	FACILITY NUMBER: 434414645
	VISIT DATE: 06/03/2024

NARRATIVE

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Discussion
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/.

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 regulatory violations were observed during today’s inspection.

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, Juan Wu, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview conducted and report was reviewed with the licensee, Juan Wu.
Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena Chin	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC809 (FAS) - (06/04)

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