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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416348
Report Date: 06/18/2024
Date Signed: 06/18/2024 09:24:52 AM

Document Has Been Signed on 06/18/2024 09:24 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:BAI, XIAOFACILITY NUMBER:
434416348
ADMINISTRATOR/
DIRECTOR:		BAI, XIAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 888-1302
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
06/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Xiao BaiTIME VISIT/
INSPECTION COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Oscar Huang met with licensee, Xiao Bai for an unannounced case management visit in order to amend inspection reports on 6/11/2024. LPA explained the nature of today’s inspection to licensee.

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, Xiao Bai.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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