434416340-12-7-2021-07-CC-YHUG-C9GQK5-20211207111347

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416340
Report Date: 12/07/2021
Date Signed: 12/07/2021 11:15:54 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:	SU, SONG		FACILITY NUMBER:	434416340
ADMINISTRATOR:	SU, SONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 378-3251
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	14	CENSUS: 1	DATE:	12/07/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Song Su		TIME COMPLETED:	11:45 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Oscar Huang conducted an announced prelicensing inspection and met with Song Su, Applicant for a large Family Child Care Home license. LPA also observed licensee's husband at home and her infant son.

The adults that reside in the home is applicant and her husband. Days and hours of operation will be Monday - Friday from 8:30 AM to 6:00 PM. LPA advised Applicant that her 4 years school-age daughter & new born son will be accounted for her capacity during her operation hours. Applicant has completed her Preventative Health and Safety Child Care Training which includes an hour of nutrition & lead poisoning prevention on 07/17/2021, and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 08/2023. Applicant rent the home and a copy of lease agreement and owner consent are on file. LPA reminder Applicant if she did not purchase liability insurance, she will need to issue affidavit regarding liability insurance for her Family Child Care Home to the parent of child in care.

The Applicant agreed to give LPA a tour of the home both indoor/outdoor during today's tele-inspection. The entire home was inspected for health and safety hazards. LPA observed gated stairs inside the home. The main area of the home is used for the day care are living room, family room, dinning room and downstair Bedroom (#1). LPA observed one screened fireplaces. Off limit areas inside are entire second floor, kitchen, and garage. LPA observed at least one functioning smoke detector and a working carbon detector and a 3A40BC fire extinguisher, fenced backyard, and no bodies of water. Off limits outdoor are outside gated half high fence. 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 they have a hand gun & shut gun,LPA observed firearms are not loaded and are locked up. Ammunition is stored and locked away separately from firearms. LPA observed a hand size hamster. 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. Applicant was advised to keep temperature within 68-85 degrees.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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 3

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: SU, SONG	FACILITY NUMBER: 434416340
	VISIT DATE: 12/07/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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. Licensee, Song Su 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, Song Su 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 [facility representative] 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.

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. Applicant completed her training on 7/17/2021 and the certification is on file.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: SU, SONG	FACILITY NUMBER: 434416340
	VISIT DATE: 12/07/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Forms of discipline were discussed with Applicant. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA discussed SB 792 Immunization Requirement with Applicant. LPA observed appropriate records and physician notes for immunization against measles, pertussis, and influenza for Licensee and in file.

LPA reviewed COVID-19 infection prevention guidance & self-assessment with Applicant including the plans in place to protect and to support staff &children, as well as essential protective equipment and supplies, cleaning & hygiene implementation, arrival procedures, health screening & social distancing practices and meal times.

LPA advised Applicant that 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.

A fire clearance approval from San Jose Fire Department was received on 12/2.

LPA conducted an exit interview and advised the Applicant, Song Su that her large Family Child Care Home license is now pending on the management approval.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3