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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415693
Report Date: 08/13/2019
Date Signed: 08/13/2019 12:09:47 PM

COMPREHENSIVE INSPECTION
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:LEE, HANFACILITY NUMBER:
434415693
ADMINISTRATOR:LEE, HANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 599-4381
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 11DATE:
08/13/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Han Lee [A.K.A. Jesse]TIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Tuoc Doan and Pietro Hernandez conducted an unannounced Annual Inspection of the Family Day Care home. Upon arrival LPAs met with Assistant Providers Fang [A.K.A. Debbie] Yeh and Ritikakuma Vidyarthi who informed LPAs that they were the only adults present in the home at the time. Licensee Han Lee arrived and met with LPAs approximately 20 minutes later.

LPAs explained the purpose of the inspection. Present during the inspection were 11 children in care, of whom one was infant age. Licensee stated that she understands that when she has more than 12 and up to 14 children, one child has to be attending school and one child has to be at least 6 years old. Licensee also stated that she understands she must comply with the capacity requirement of a small Family Child Care Home whenever there is only one care provider home with the children.

The home’s operating days and hours are Monday through Friday from 08:30 AM to 06:00 PM. The home maintains telephone service. The License and Notification of Parents’ Rights were observed to be posted. The home was inspected inside and out. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. LPAs did not observe flies, other insects, or rodents during the inspection. The observed children’s toys, play equipment, and furniture were in good condition. There were no baby walkers at the day care. Bathroom used by children was observed to be clean and in operating condition. Food preparation area was clean.

The whole second floor, and all three bedrooms and Garage on the first floor are Off Limits. Staircase leading up to the second floor is kept inaccessible to children. Backyard is fenced and is used for outdoor activity. There were no bodies of water observed. Licensee stated that there were no weapons stored on the premises. A fully charged fire extinguisher was observed. Carbon monoxide and Smoke Detectors were tested and proved to be functioning. Fire/Disaster Drills were last conducted on 06/03/19. Licensee stated that the day care does not provide transportation to the children.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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 4
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: LEE, HAN
FACILITY NUMBER: 434415693
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited
CCR
102369(b)(9)
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APPLICATION FOR LICENSE. Licensees and any adult in the home, shall provide evidence of a current tuberculosis clearance, performed and signed by a physician not more than one year prior to or seven days after first day of employment.
This requirement is not met as evidenced by:
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BY POC DUE DATE, 08/23/19, Licensee agreed to obtain documentation showing evidence of Tuberculosis (TB) clearance for Assistant Provider Ritikakuma Vidyarthi . A copy will be sent to Licensing Office to show proof of correction.
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Per LPAs' review of records, Assistant Provider Ritikakuma Vidyarthi has been working at the day care for more than 7 days, but was not able to show LPAs proof that she has TB Clearance during the inspection. This poses a potential risk to the health and safety of children 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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: LEE, HAN
FACILITY NUMBER: 434415693
VISIT DATE: 08/13/2019
NARRATIVE
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LPAs reviewed and obtained a copy of the roster of children in care. Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Emergency Medical Treatment, Receipt for Parents' Rights Notice, and Immunization. Licensee and Assistant Providers Fang Yeh and Ritikakuma Vidyarthi's files were reviewed, which included Criminal and Child Abuse Background Check Clearance, immunization record, required Training etc. Licensee's AB1207 Mandated Reporter Training expires on 10/27/2019. Both Assistant Providers' Pediatric CPR/1st Aid Certification expires on 04/2021.

Adults who are over the age of 18 and reside in the home are Licensee and Licensee's three tenants. They have Clearances for Tuberculosis, Criminal Background Check, and Child Abuse Index Check. LPAs 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPAs reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, etc. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe Sleep information was also reviewed and provided to Licensee.

This facility provides Incidental Medical Services – IMS, Epinephrine. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.

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: http://www.ada.gov/childqanda.htm.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LEE, HAN
FACILITY NUMBER: 434415693
VISIT DATE: 08/13/2019
NARRATIVE
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In the areas that were evaluated, one regulatory violation was observed at the time of the inspection. Exit Interview was conducted, where this report, the violation, plan of correction, and appeal rights were reviewed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4