434416585-11-6-2024-07-CC-AYAG-D9V2PN-20241008173436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416585
Report Date: 10/08/2024
Date Signed: 11/06/2024 10:01:13 AM

Document Has Been Signed on 11/06/2024 10:01 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:	LAI, CAIXIA		FACILITY NUMBER:	434416585
ADMINISTRATOR/ DIRECTOR:	CAIXIA LAI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 695-9982
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95131
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 7	DATE:	10/08/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Caixia Lai		TIME VISIT/ INSPECTION COMPLETED:	05:45 PM

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10/08/2024, at 1:00 PM, Licensing Program Analysts (LPAs) Andy Yang and Melvin Matos met with Applicant, Caixia Lai, to conduct an announced Pre-licensing inspection to address a change of location request. Previous facility number is 435700360. Present for this inspection was Applicant, Assistant 1, Assistant 2, Adult Daughter, and total of 7 day care children (3 Infants and 4 preschool age). The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday to Friday 8:30 AM to 5:00 PM. Total children enrolled is 8, and the age range is 1 to 4 years old. People residing in the home are the Applicant and 4 adult renters who live in the off limit upstairs area of the home. Applicant's adult daughter also assisted with translation (Mandarin) for the Applicant during today's inspection.

The home is a Single Family Home with two levels. The home consists of: (1st floor) play room, dining area, kitchen, infant room, bathroom, laundry room, garage, (2nd floor) 3 bedrooms, master bedroom, master bathroom, bathroom, backyard. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are play area (living room), dining area, infant room (bedroom), and bathroom. The OFF LIMIT AREAS are laundry/wash room, garage, kitchen, entire (2nd floor)3 bedrooms, bathroom, master bedroom, master bathroom and left and right side yard (backyard) which will be inaccessible via barricaded stairs and closed and/or locked doors. The ISOLATION AREA will be the infant room.

LPAs toured the facility and observed 3 preschool age children (2 years and older) awake in 3 separate infant play pen in the dining area. LPAs reminded the Applicant that play pens are age appropriate for infants (under 24 months of age) and are not age appropriate for children 2 years and older. LPA observed 3 play pens in dining area, and 4 play pens in the infant room. LPAs observed backyard has a gated play area that limits access to right side yard to where the gate is located for emergency access.

The outdoor play area is free from defects or dangerous conditions are fenced and supervised. There are ample age-appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children, and it was observed that there are no toxins or hazardous items accessible today. Applicant states that any poisons are stored in laundry room which is OFF LIMITS. LPAs reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes.

This is an amended version of the original report created on 10/08/2024.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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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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: LAI, CAIXIA	FACILITY NUMBER: 434416585
	VISIT DATE: 10/08/2024

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Applicant, Caixia Lai, was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPAs reviewed with the Applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Pre-licensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

LPAs discussed the safe sleep regulations with Applicant, Caixia Lai, 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 Applicant 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.

On this date, 08/20/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Fire clearance approval was received from the San Jose Fire Department prior to today's inspection.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LAI, CAIXIA	FACILITY NUMBER: 434416585
	VISIT DATE: 10/08/2024

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Exit interview conducted and report was reviewed with the Applicant, Caixia Lai. LPAs advised the Applicant that a Large Family Child Care Home license will be approved upon completion of the following and Licensing Program Manager's approval:

1) Updated sketch LIC 999A (Backyard) with updated on and off limit areas must be submitted by Friday October 11, 2024.

2) Updated LIC 279 application - to update contact number for Applicant and adults living in the home must be submitted by Friday October 11, 2024.

3) TB test results for four renters residing in the home have been submitted by Friday October 18, 2024.

4) Proof of residency verifying that the Applicant resides in the current home, including updated lease agreement, has been submitted by Monday October 14, 2024.

5) Left side section of backyard is cleaned of debris & materials by Friday October 11, 2024.

This is an amended version of the original report created on 10/08/2024.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: LAI, CAIXIA	FACILITY NUMBER: 434416585
	VISIT DATE: 10/08/2024

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The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. LPAs reminded Applicant to submit an updated LIC 279 with correct phone number. The Applicant's CPR and First Aid certificate is current and expires 03/24/2026. Applicant is exempt from the Mandated Reporter Training for Child Care Providers due to language (Mandarin). Applicant CPR/First aid certifications needs to be renewed every two years. A copy of the Applicant’s immunization record is on file. Per Applicant, there are no firearms in the home

Applicant states that she does not administer any medication to the children at this time. Applicant states that a child will be isolated in the ISOLATED AREA if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home. Also discussed with Applicant the requirements for reporting suspected child abuse, unusual incidents/injuries, and heat related illnesses.

Forms of discipline to be used by Licensee is talk with the child and redirection. Applicant understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature. LPAs informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPAs observed the Property Owner/Landlord Notification form (LIC 9151) that the Applicant confirms was provided to the property owner/landlord. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Copies of both documents are on file. Applicant provided proof of control of property to the Department prior to today’s inspection and a copy of the rental agreement is on file. Updated lease agreement will need to be submitted to the Department to reflect that the Applicant is a "tenant" of the home. Applicant will obtain liability insurance for the day care once she gets licensed.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/08/2024 05:35 PM - It Cannot Be Edited

Created By: Andy Yang On 10/08/2024 at 04:37 PM

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: LAI, CAIXIA	FACILITY NUMBER: 434416585
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

Type A

Section Cited

HSC

1596.80

No person, firm, partnership, association, or corporation shall operate, establish, manage, conduct, or maintain a child day care facility in this state without a current valid license therfor as provided in thi act. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPAs Yang and Matos observed seven day care children (3 infants & 4 preschool) in care during today's inspection. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/09/2024
	Plan of Correction
1 2 3 4	Department has a pending application on file for a change of location to Applicant's current location. Applicant agreed to provide a written/signed statement stating that she understands the licensing process and that a day care cannot operate with a valid license from the Department.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Belinda Devall

LICENSING EVALUATOR NAME:

Andy Yang

LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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