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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414645
Report Date: 07/22/2024
Date Signed: 07/22/2024 02:40:36 PM

Document Has Been Signed on 07/22/2024 02:40 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, JUANFACILITY NUMBER:
434414645
ADMINISTRATOR/
DIRECTOR:		WU, JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 649-6477
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Juan WuTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Andrea Cortez and Anna Morales conducted a Unannounced Case Management Inspection and was greeted by Staff Ms Julee and Licensee Juan Wu aka (Joanne Wu). Present during inspection, two assistants Ms Julee and Ms Briana.

The facility census is 11, one infant, and 10 preschoolers aged children.

LPA's toured inside and outdoor of home. Upon entry, LPA's observed Ms Briana and children engaging in story time activities located in the learning area. LPAs observed a (C1) restrained while sitting in highchair (without food) during the reading activity. In addition, LPA's observed a brown and white colored play pin lose and wobbling.

LPA's Andrea Cortez and Anna Morales informed licensee that this report dated 7/22/2024 document(s) 1 TYPE A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA's, also, informed Licensee that a TYPE B citation will be given for the broken play pin.

LPA's informed Licensee to provide a copy of this licensing report dated 7/22/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Right given

Type A and B deficiencies were cited at today's visit.

Exit interview was conducted with Licensee Juan Wu.

Gladys Kuizon
Andrea Cortez
DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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Document Has Been Signed on 07/22/2024 02:40 PM - It Cannot Be Edited


Created By: Andrea Cortez On 07/22/2024 at 01:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WU, JUAN
FACILITY NUMBER: 434414645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/23/2024
Section Cited

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Personal Rights:102423(a)(2) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or
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authorization from the child's authorized representative. These rights include, but are not limited to, the following:(2)To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: LPA's observed C1 restrained in highchair during reading activity without food. This poses an immediate risk to the health, safety, and personal rights of children in care.
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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.
Request Denied
Type B
07/29/2024
Section Cited

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102417(d) Operation of a Family Child Care Home. The home shall provide safe toys, play equipment and materials.
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This requirment is not met as evidenced by: LPAs observed play pin broken and not safe for the child use/acess, which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Andrea Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024


LIC809 (FAS) - (06/04)
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