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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416178
Report Date: 07/16/2020
Date Signed: 07/16/2020 03:04:21 PM

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:CHEN, LIJUANFACILITY NUMBER:
434416178
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
07/16/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lijuan ChenTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Oscar Huang conducted an announced case management tele-inspection via video conference call (FaceTime) with Lijuan Chen, Licensee. The purpose of today's tele-inspection is to conduct an inspection in response to licensee's increase request. Licensee rents the home. A copy of lease agreement is on file. LPA observed six children (two infants & 4 preschoolers) & an adult assistant at home. Days and hours of operation are Monday to Friday, 8:00am to 6:00pm. The adults that reside in the home are Licensee, her sister-in-law (also as an assistant).

Licensee agreed to give LPA a tour of the indoor/outdoor area via FaceTime during today's tele-inspection. The entire home was inspected for health and safety hazards.The main area of the home is used for the day care are living room, kitchen, bedroom #2, master bedroom & bathroom#1. LPA observed a screened fireplace. Off limit areas inside the home: master bathroom, bedroom #1, and the detached garage. LPA observed at least a combined functioning smoke/carbon monoxide detector on the living room ceiling, and one working carbon monoxide detector on the wall of kitchen above counter top, and a 3-A-40-BC fire extinguisher, fenced backyard, and no bodies of water. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Applicant states that there are no weapons or pets in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded licensee that smoking, drop side cribs, and baby walkers, bouncers, excer-saucers, jumpers etc. are not allowed in Family Child Care Homes.



A review of staff records on today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA 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.

Licensee stated she carries the child care liability insurance under DCI. LPA observed Licensee and her assistant have current CPR and First Aid certification expiring 06/2021 & 11/2021 respectively. LPA also observed licensee's proof of Preventative Health and Safety Child Care Training on file, taken on 06/09/2019, which includes an hour of nutrition.
Facility Evaluation Report dated 07/16/2020 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHEN, LIJUAN
FACILITY NUMBER: 434416178
VISIT DATE: 07/16/2020
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Facility Evaluation Report dated 07/16/2020 to be continued from previous page:
Licensee had renewed her mandated reporter training on 05/08/2020 and her certification was on file. Her sister-in-law (assistant) also completed her training on 05/09/2020, and her certification was on file. LPA observed appropriate records for immunization against measles, pertussis, and influenza for Licensee & her assistant, and were on file.

Supervision of children was discussed with Licensee, and she understands that they 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 they do not transport children via vehicle but they understand that children cannot be left in parked vehicles unattended at any time. LPA reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing. Incidental Medical Services (IMS) were discussed with Licensee. Licensee is not providing IMS at this time. If in the future any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

LPA reviewed COVID-19 infection prevention guidance & self-assessment with licensee including her plans in place to protect and support staff, children, cleaning & hygiene implementation, health screening & social distancing practices. LPA observed posters & visitor notice were posted at the front entrance.

A fire clearance approval from the Sunnyvale Fire Department was granted on 07/06/2020: Fire clearance granted. No children allowed in the garage, bedroom #1, and two side yards (to the right of the garage & the outside of the bedrooms).

The licensee was informed that due to the current COVID-19 pandemic and "Shelter In Place" Order, today's report (Facility Evaluation Report - LIC 809 &LIC809-C) will be emailed to the licensee's email address at chen7483chen@icloud.com with "Read Receipt" notification. The licensee understands that her response to the email is considered an acknowledgement of "receipt" of today's report.

LPA conducted an exit interview with Licensee, and advised her that her large FCCH license is now pending upon the following item and the management approval:



1. Proof of Preventative Health and Safety Child Care Provider Training which contains the new 2020 Lead Poisoning Prevention update.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020
LIC809 (FAS) - (06/04)
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