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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415404
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:43:37 PM

Document Has Been Signed on 11/17/2022 03:43 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:WANG, XIAOFANGFACILITY NUMBER:
434415404
ADMINISTRATOR:WANG, XIAOFANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 218-2864
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:TIME COMPLETED:
02:30 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 Analyst (LPA) Oscar Huang conducted an unannounced case management - incident inspection to the facility in regard to the department receive a call this morning from Sunnyvale Fire Department that due to oven mechanical failure that caught the facility kitchen partially on fire that occurred in the afternoon on Sunday, 11/13/2022. The facility is impacted and can not operate as normal until cleanup and restoration occurs. Upon arrived, LPA observed a restoration truck parked on the drive way in front of the house with the front door left ajar. LPA did not observe any children nor licensee or her family on site except three cleaning workers. LPA conducted a quick conversation with them and then contacted licensee via phone call. See detail information documented on LIC812.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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 1