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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414251
Report Date: 09/16/2021
Date Signed: 09/16/2021 12:13:22 PM

Document Has Been Signed on 09/16/2021 12:13 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:TIAN, TIANFACILITY NUMBER:
434414251
ADMINISTRATOR:TIAN, TIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 502-9222
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tian TianTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee, Tian Tian for an unannounced required annual inspection. LPA explained the nature of today’s inspection to Licensee. LPA observed 12 preschool daycare children in the home during today's inspection. Days and hours of operation are Monday to Friday, 8:30am. to 6:00pm. The adults that reside in the home are Licensee only.
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. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, Licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care.
LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. The main area of the home is used for the day care are family room, dinning room, a bedroom and a bathroom. LPA observed a barricaded 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 inaccessible to children. LPA observed a fully charged 2A10BC fire extinguisher, a working smoke detector, and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: a master bedroom, study room, kitchen and the garage. LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: gated right side yard. Temperature was measured at 70 degree F by thermostat on the wall, Licensee was advised to keep temperature within 68-85 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee's parent own the house. Licensee does not child care liability insurance, LPA observed Affidavit Regarding Liability Insurance For Family Child Care Home were signed by the parents and kept in each child's file.
LPA observed Licensee has CPR and First Aid certifications expiring since 06/2021. LPA observed a staff has current one expiring on 12/2021. LPA observed a current roster of the children. The last drills were conducted on 08/09/2021. LPA reviewed all 12 children files mandated by the regulation including immunization records are maintained and up-to-date, and Notification of Parents’ Rights is in each child’s file.
Facility Evaluation Report dated 09/16/2021 to be continued on next page:
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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: TIAN, TIAN
FACILITY NUMBER: 434414251
VISIT DATE: 09/16/2021
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Facility Evaluation Report dated 09/16/2021 to be continued from previous page:
Supervision of children was discussed with Licensee, and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. Licensee states that she does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time. LPA reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document as well as the most recent PIN 20-24-CCP for Infant SafeSleep and the requirement for checking and logging during the nap in every 15 minutes, including LIC 9227 for infants under one year old. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing.
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 all children above 2 shall be taught to wear face masks, LPA observed all children were wearing 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 and helper. LPA observed appropriate records for immunizations against measles, pertussis, and influenza for them in file. Incidental Medical Services (IMS) were discussed with Licensee and her helpers. Licensee is not providing IMS at this time. 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: http://www.ada.gov/childqanda.htmLicensee will submit a plan of operation for IMS if in the future they provide any IMS to a child in care.
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 & her helpers requested to be exempted until Chinese version training material becomes available.

No Deficiency was cited. Exit interview conducted 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: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC809 (FAS) - (06/04)
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