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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415392
Report Date: 05/02/2024
Date Signed: 05/02/2024 10:53:37 AM

Document Has Been Signed on 05/02/2024 10:53 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:SHANG, ANN IFACILITY NUMBER:
434415392
ADMINISTRATOR/
DIRECTOR:		ANN I SHANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 992-5576
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
05/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Ann ShangTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced Plan of Correction (POC) to the Facility today. LPA met with licensee Ann Shang, and explained the nature of today's visit to her. The purpose of the inspection is to review POC for deficiencies that were cited on 4/22/2024. Present during today's inspection were licensee, two helpers and 10 preschoolers and an infant.

The facility was issued a "Type A" deficiency and a "Type B" deficiency on 4/22/2024 for operating over capacity and missing Infant 15 min. sleeping check logs. The Plan of Correction was due on 4/23/2024 & 5/06/2024 respectively.

LPA observed the Notice of Site Visit, LIC 9099 & LIC 9099-D reports which were issued 4/22/2024 were posted on wall next to the facility entrance door. Licensee submitted the plan of correction statement to CCL on site. LPA observed that the Acknowledge of Receipt of Licensing Reports were signed by the parents of children in care and kept in each child's records, as well as 15 min. infant sleeping logs for infants under 2 years old.

LPA concludes that the facility has completed its required plan of corrections and the deficiencies are thus cleared as of today's visit.

No deficiency was cited. A notice of site visit was given and must remain posted for 30 days. The report was discussed and verbally translated into Chinese during the exit interview with licensee, Ann Shang.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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