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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410869
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:55:14 AM

Document Has Been Signed on 10/12/2021 11:55 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:OU, LIDANFACILITY NUMBER:
434410869
ADMINISTRATOR:OU, LIDANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 366-2607
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
10/12/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Lidan OuTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA), Marilou Monico, conducted a Plan of Correction (POC) inspection. Licensee was cited on September 29, 2021 under Staffing Ratio and Capacity. LPA met with Licensee, Lidan Ou, and informed her the purpose of today's visit. Also present in the home were licensee's adult assistant and 12 daycare children including one infant and 11 preschool age. LPA observed 13 signed Acknowledgement of Receipt of Licensing Report (LIC 9224).

The deficiency under Staffing Ratio and Capacity is hereby corrected and cleared.

There were no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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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