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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414786
Report Date: 03/25/2022
Date Signed: 03/25/2022 11:41:01 AM

Document Has Been Signed on 03/25/2022 11:41 AM - It Cannot Be Edited

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:PING, JENNIFER MARLENEFACILITY NUMBER:
434414786
ADMINISTRATOR:PING, JENNIFER MARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 805-9116
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jennifer PingTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year Inspection at the day care home today and met with Licensee, Jennifer Ping. There were 7 children present in the home today which 4 are infants. Present also in the home is Licensee's daughter which is also the staff. Days and hours of operation is Monday - Friday, 7:30AM to 5:30PM. The Licensee, her husband and her 3 minor children also live in the home. All adults or other individuals who require caregiver background checks have received criminal record and child abuse index clearance or exemptions.

LPA inspected the home inside the out with the Licensee. The home was observed to be well maintained and organized. The home has a fire extinguisher, carbon monoxide and smoke detector and a working telephone. LPA observed sufficient toys and play equipment for the day care children. Per Licensee, they don't have firearms and ammunition stored in the home. Off limit areas inside the home: 3 bedrooms including master bathroom and garage. Off limit areas outside the home: 2 side yards and 2 sheds. The outside play area is surrounded by fence and was observed to be free of any hazards. No bodies of water were observed.

LPA reviewed the current Child Care Facility Roster and children's records during today's inspection. The records reviewed include but not limited to emergency contact information, immunization records, consent for medical treatment and parent's rights. Emergency Disaster Drill Log was reviewed and the last drill was conducted on 1/20/2022.

Licensee's and staff record were reviewed. Licensee's CPR/1st Aid certification is valid through July 2023. Licensee's and staff's Mandated Reporter Training certification are both valid through 6/6/2023. Per Licensee, she does not provide incident medical service.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PING, JENNIFER MARLENE
FACILITY NUMBER: 434414786
VISIT DATE: 03/25/2022
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


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.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

No deficiencies cited. Exit interview conducted and report was reviewed with the Licensee.

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.

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/process

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
LIC809 (FAS) - (06/04)
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