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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415404
Report Date: 01/22/2024
Date Signed: 01/22/2024 09:54:54 AM

Document Has Been Signed on 01/22/2024 09:54 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:WANG, XIAOFANGFACILITY NUMBER:
434415404
ADMINISTRATOR:WANG, XIAOFANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 218-2864
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
01/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Xiaofang WangTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced case management inspection to the facility in regard to licensee requested to modify her facility floor plan by changing daycare room from bedroom 3 to a larger bedroom 2, and extend her outdoor play ground to include the backyard and left sideyard in addition to the current right sideyard. LPA met with licensee Xiaofang Wang. LPA explained the nature of today’s inspection to Licensee. Present was licensee. LPA observed 3 infants at home. Days and hours of operation are Monday to Friday, 8:30am to 6:00pm. The adults that reside in the home are licensee and her husband.

A review of staff records on 1/22/2024 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violate.
LPA toured the indoor and outdoor areas of the home during today’s inspection. The entire home was inspected for health and safety hazards. LPA observed no construction/structure changes to the facility. Day care use indoor areas include living room, dinning room, and bathroom 1. Off limit areas inside the home: Rooms 1 & 3, the master bathroom, furnace closet, kitchen, attached garage. Outdoor play area include all inner fences right side, backyard, and left sideyard. Off limit area outside the home: a locked shed in the backyard, and a fenced above-ground spa with cover and locked in the left side yard.
LPA observed Licensee has current CPR and First Aid certification expiring 07/2024. LPA observed a fully charged 3A40BC fire extinguisher on the wall in the kitchen, a working carbon monoxide detector at the ceiling in bedroom 2, 5 working smoke detector at the ceiling in hallway, living room, and 4 bedrooms.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, XIAOFANG
FACILITY NUMBER: 434415404
VISIT DATE: 01/22/2024
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LPA observed sufficient materials, toys, play equipment, and nap equipment for the day care children. The home is clean, orderly, and safe for the day care children. Licensee states that there are no weapons or pets in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded licensee that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed no screened open face wall heater. Temperature was measured at 72 degree F by thermostat on the wall. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee owns the house.

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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: WANG, XIAOFANG
FACILITY NUMBER: 434415404
VISIT DATE: 01/22/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the licensee, Xiaofang Wang confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
No Deficiency was cited. Exit interview conducted with Licensee, Xiaofang Wang and advised her that the changes from an area of her family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care both indoor and outdoor are becoming effective as of today.

The report was discussed and verbally translated into Chinese during the exit interview 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: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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