<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411007
Report Date: 11/01/2024
Date Signed: 11/01/2024 04:30:46 PM

Document Has Been Signed on 11/01/2024 04:30 PM - 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:YU, ZHIDONGFACILITY NUMBER:
434411007
ADMINISTRATOR/
DIRECTOR:		YU, ZHIDONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 505-9859
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
11/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Zhidong YuTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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 Analysts (LPAs) Marilou Monico and Shine Yu conducted a Case Management inspection. LPAs met with Licensee, Zhidong Yu. Based on LPAs observations and interviews, an adult assistant (S1) is working in the home without fingerprint clearances. LPAs learned from interviews that an incident that occurred few months ago involving a child (C1) who required immediate medical attention was not reported to Licensing.

As a result, deficiencies were cited on the following pages:

Exit interview conducted and report was reviewed with Licensee, Zhidong Yu

A Notice of SIte Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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
Document Has Been Signed on 11/01/2024 04:30 PM - It Cannot Be Edited


Created By: Marilou Monico On 11/01/2024 at 03:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: YU, ZHIDONG
FACILITY NUMBER: 434411007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2024
Section Cited
CCR
102370(d)(1)

1
2
3
4
5
6
7
Criminal Record Clearance - (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
1
2
3
4
5
6
7
By POC due date: 11/04/14, Licensee will submit a written plan to ensure that all adults shall obtain fingerprint clearances prior to working in the home.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Licensee's adult assistant (S1) is working in the home without fingerprint clearances. This poses an immediate risk to the health, safety, and personal rights to children in care.
A civil penalty of $100 was assessed.
8
9
10
11
12
13
14
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/01/2024 04:30 PM - It Cannot Be Edited


Created By: Marilou Monico On 11/01/2024 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: YU, ZHIDONG
FACILITY NUMBER: 434411007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2024
Section Cited
CCR
102416.2(b)

1
2
3
4
5
6
7
Reporting Requirements - (b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. (1) Medical treatment means treatment by a medical professional, as defined in Section 101152(m).
1
2
3
4
5
6
7
By POC due date: 11/06/24, Licensee to submit a written plan to ensure that unusual incidents shall be reported to Licensing within the required time frame.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
LPAs learned from interviews that an incident involving a child (C1) who required immediate medical attention was not reported to Licensing. This poses a potential risk to the health, safety and personal rights to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3