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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416329
Report Date: 01/16/2025
Date Signed: 01/22/2025 08:06:27 AM

Document Has Been Signed on 01/22/2025 08:06 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:XU, BINGMEIFACILITY NUMBER:
434416329
ADMINISTRATOR/
DIRECTOR:		XU, BINGMEIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 288-4202
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
01/16/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:32 AM
MET WITH:BingMei XuTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Shine Yu, conducted an unannounced Annual Inspection 8:32 am. LPA met with licensee BingMei Xu.

LPA observed the following materials posted on the bulletin board, including the Facility License, Notification of Parents' Rights (PUB 393) and Fire Drill check log. The last fire drill conducted was 7/26/2024. Licensee acknowledged the drill has to be conducted once every 6 month. Facility's operating hours are Monday to Friday 8:30AM to 6PM. One enrolled child is half time and the remaining enrolled children enrolled now are full time. LPA acquired a copy of current Children's roster. Present are 1 employee and 8 children, including 4 under 2 years old. LPA observed 15 minutes check list.

LPA reviewed a random selection of children's file and observed that notification of parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file. 3 out 6 children files does not have parent's signature on LIC 995A form. LPA also reviewed the staff files for the following records: LIC 9052 Employee Rights, the Immunization Record showing immunity to measles (MMR), pertussis (Tdap). Licensee's pediatric First Aid & CPR expires at May, 2025. The Employee Chen's pediatric 1st Aid & CPR expires 6/22/2026. Her background check is clear but not associate the facility. Licensee stated she faxed LIC 9182, June, 2024.

LPA toured the facility indoor and outdoor with licensee. Licensee keep the bathroom organized and clean. There is smoke detector in class room and kitchen. The carbon monoxide detector in living room. LPA observed one crib in bedroom. Licensee stated only one child comes 2 days per week. LPA stated regulation 102425(a)(6), each infant's bedding shall be used for him/her only. Bedding that touches the infant's skin shall be cleaned at least weekly or before use by another infant. There are age appropriate toys for children. Licensee stated there is no firearm and no fireplace in the facility. There is no body of water observed outside of play yard. The outdoor play area is enclosed with appropriate fence and safe for children. LPA observed the indoor temperature is 57 degrees. LPA advised licensee the regulation 102417 (b) that the home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

Continue on next page, LIC 809C

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: XU, BINGMEI
FACILITY NUMBER: 434416329
VISIT DATE: 01/16/2025
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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 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.

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-andresources/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.

Licensee stated there is no medication provided in the facility. 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/.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Continue on next page, LIC 809C.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: XU, BINGMEI
FACILITY NUMBER: 434416329
VISIT DATE: 01/16/2025
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The 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.

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.

Exit interview conducted and report was reviewed with licensee, BingMei Xu.

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



A Notice of Site Visit was given and must remain posted for 30 days

The report was discussed and verbally translated into Mandarin during the exit interview with Licensee, BingMei Xu.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/22/2025 08:06 AM - It Cannot Be Edited


Created By: Syhshyan Yu On 01/16/2025 at 11:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: XU, BINGMEI
FACILITY NUMBER: 434416329

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 6 children files does not have parent's signature on LIC 995A form which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2025
Plan of Correction
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Licensee stated she will have parents sign on LIC 995A form right away. Licensee stated for new enroll student, will make sure parent sign the form and give parent a copy of signed form.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


LIC809 (FAS) - (06/04)
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