434416229-8-23-2023-07-CC-FRAA-CUYLVF-20230823090528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416229
Report Date: 08/22/2023
Date Signed: 08/23/2023 09:05:36 AM

Document Has Been Signed on 08/23/2023 09:05 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:	TAN, CHUNHUI		FACILITY NUMBER:	434416229
ADMINISTRATOR:	CHUNHUI TAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 828-8020
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 10	DATE:	08/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:17 AM
MET WITH:	Chunhui Tan		TIME COMPLETED:	03:35 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	On 08/22/2023, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Chunhui (Sierra) Tan, and explained the nature of today’s inspection. Present in the home were licensee, two assistants, behavior therapist and 10 preschool children. Licensee was operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 8:30 am to 5:00 pm. LPA observed all required posted materials near the front entrance to the home. The adults that reside in the home are licensee and spouse. Licensee has one minor child residing in the home. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-828-8020). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs and shelves, are in good condition. The floors were free of tripping hazards with toys put away in shelves. The home has central heating/cooling and ventilation for comfort of children. The home is single story. Off limit areas inside the home: Master Bedroom, master bathroom, two bedrooms, kitchen, storage room and attached garage. Off limit areas outside the home: gated left and right side sections. Backyard is fenced and both sides of the home are gated. The outdoor space and play equipment were observed to be age appropriate and free of hazards. Shade is provided with canopies. There are no bodies of water observed. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. The shower area is free of any hazards. LPA observed a fully charged 2A10BC fire extinguisher near the front entrance and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, poisons, medications, sharp objects and other similar items were observed to be stored inaccessible to children. LPA observed a first aid kit in the atrium of the home. Licensee understands that smoking is prohibited in the home. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TAN, CHUNHUI	FACILITY NUMBER: 434416229
	VISIT DATE: 08/22/2023

NARRATIVE

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Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides lunch and snacks to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Licensee participates in the Love Little Children Inc. Food Program. Licensee states that a child will be isolated if necessary due to illness or communicable disease.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was last conducted on 06/20/2023. LPA obtained copy of children's roster.

Children file review was completed and found to be current and up to date. Ten (10) children’s files were reviewed during today's inspection. Licensee carries daycare insurance and LPA observed a current policy verifying valid coverage.

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 provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age. 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.

LPA reviewed three (3) staff files (Licensee and two assistant's) for the required forms. LPA confirmed through file review that the CPR/First Aid Training and Mandated Reporter Training were up to date for each staff member present at the time of the inspection, and that all staff members were associated with the facility in Guardian and all staff present had passed criminal background checks. One assistant staff (S3) does not have the required immunization's for measles, pertussis and influenza but is a new employee and has 30 days to complete required immunization's. Licensee stated that she will have staff complete immunization's within 30 days of employment and maintain proof in file.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed
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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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: TAN, CHUNHUI	FACILITY NUMBER: 434416229
	VISIT DATE: 08/22/2023

NARRATIVE

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Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty 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. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Continued on Page 4

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: TAN, CHUNHUI	FACILITY NUMBER: 434416229
	VISIT DATE: 08/22/2023

NARRATIVE

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During the exit interview, licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. 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.

As a result of today's inspection there were no deficiencies cited.

Exit interview conducted and report was reviewed with the licensee, Chunhui Tan.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC809 (FAS) - (06/04)

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