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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416339
Report Date: 11/04/2021
Date Signed: 11/04/2021 10:48:06 AM

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:KOU, RUIXUEFACILITY NUMBER:
434416339
ADMINISTRATOR:KOU, RUIXUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 669-6390
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: 0DATE:
11/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:RuiXue KouTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee, Ruixue Kou for an announced inspection in response to licensee relocation request. Licensee currently has a large FCCH license (#434415387) located at 773 Layton Street, San Jose, CA 95051. LPA explained the nature of today’s inspection to Licensee. LPA observed no children at home. Days and hours of operation are Monday to Friday, 8:30am to 6:00pm. The adults that reside in the home are Licensee. Licensee has completed an additional one hour Lead Poisoning Prevention to her 8 hours of Preventative Health and Safety Child Care Training on 03/13/2016, and a copy of the certification card is on file. Applicant's CPR and First Aid certifications are current and expire on 03/2022. Applicant rents the home and a copy of lease agreement & Landlord consent are also on file. LPA advised Licensee that her school age son will be accounted for her capacity when present during her operation hours.

Licensee Ruixue Kou 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 toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Licensee was advised to keep temperature within 68-85 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. LPA observed no stairs inside the home. The main area of the home is used for the day care are Daycare room and bathroom #1. LPA observed a screened fireplace. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored in top cabinets in the kitchen inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, at least one working smoke and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms and pets in the home. Off limit areas indoor: all 3 bedrooms, kitchen, and garage. LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: two gated side yards, and a locked storage shed.


Facility Evaluation Report dated 11/04/2021 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: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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: KOU, RUIXUE
FACILITY NUMBER: 434416339
VISIT DATE: 11/04/2021
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LPA discussed the safe sleep regulations with licensee, Ruixue Kou 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.

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, meal times and arrival & pickup procedures. LPA observed posters & visitor policy notice were posted at the front entrance. LPA advised that child above 2 years old shall be taught to wear masks.



LPA discussed AB 2231: Civil Penalty Updates effective July 1, 2017 with Licensee. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. A $100 per day for each violation for Failure to Correct, and $250 immediately and $100 per day per violation until corrected for Repeat Violations.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records and statement for immunizations against measles, pertussis, and influenza for her in file.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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/childqanda.htm

LPA discussed Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training web site is available at: https://mandatedreporterca.com/ . Licensee has requested to be waived until the Chinese version becomes available.

A fire clearance granted from the Santa Clara Fire Department was received on 11/1//2021 and was on file: Fire clearance granted for 14 max. capacity.

Exit interview conducted and report was reviewed with the licensee, Ruixue Kou and advised her that a large Family Child Care Home license at this new location is now pending on the management approval.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
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