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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409289
Report Date: 06/28/2023
Date Signed: 06/28/2023 08:55:09 AM

Document Has Been Signed on 06/28/2023 08:55 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHAO, THERESAFACILITY NUMBER:
434409289
ADMINISTRATOR:CHAO, THERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 406-4261
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
06/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Theresa ChaoTIME COMPLETED:
09:10 AM
NARRATIVE
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced case management inspection to the facility in regard to licensee requested to temporarily use the newly built ADU for daycare use until the main house floor, kitchen, bathrooms renovation complete. LPA met with licensee Teresa Chao. LPA explained the nature of today’s inspection to Licensee. Present was licensee, her husband and an infant. The ADU was completed with Cupertino city permit as well as fire clearance granted by the Santa Clara County Fire Prevention Department.

A review of staff records on 06/28/2023 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 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 violate.

LPA toured the indoor and outdoor areas of the home during today’s inspection. The entire home was inspected for health and safety hazards. There are no stairs inside the home. Day care use area for ADU include the activity room, kitchen, and a bathroom. Off limit areas inside the home: Main house and all rooms. Off limit area outside the home: entire back yard.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHAO, THERESA
FACILITY NUMBER: 434409289
VISIT DATE: 06/28/2023
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LPA observed a fully charged 2A40BC fire extinguisher purchased on 6/15/2023 and a working combined smoke/carbon monoxide detectors. 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. Licensee 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, baby walkers, and similar items are not allowed in Family Child Care Homes. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Temperature was measured at 68 degree F by thermostat on the wall. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee rents the house.

LPA observed Licensee has current CPR and First Aid certification expiring 06/2024.

A fire clearance granted by the Santa Clara County Fire Prevention Department was received on 06/26/2023. ADU rooms approved are bathroom, children activity room and kitchen. Verified permits pulled with City of Cupertino.
* Main House and all rooms in main house are off-limits at this time plus backyard play area.

No Deficiency was cited. Exit interview conducted with Licensee, Teresa Chao and advised her that the ADU is now approved for daycare use. The report was discussed and verbally translated into Chinese during the exit interview with Licensee. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
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