<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416585
Report Date: 11/06/2024
Date Signed: 11/06/2024 09:59:13 AM

Document Has Been Signed on 11/06/2024 09:59 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, CAIXIAFACILITY NUMBER:
434416585
ADMINISTRATOR/
DIRECTOR:		CAIXIA LAIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 695-9982
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
11/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Caixia LaiTIME VISIT/
INSPECTION COMPLETED:
10:14 AM
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 11/06/2024, at 8:30 AM, Licensing Program Analysts (LPAs) Andy Yang and Mel Matos, met with Applicant, Caxia Lai to conduct a follow up announced Pre-licensing inspection. Initial Pre-licensing inspection was completed on 10/08/2024. Purpose of today's inspection: provide an "amended" Facility Evaluation Report and address correction/completion of items noted during the previous Pre-licensing inspection. LPA Andy Yang has provided Mandarin translation for Applicant.

The following were present in the home during today's inspection: Applicant, two adult assistants, and six day care children (2 Infant and 4 Preschool).

LPAs conducted a tour of the home (indoor/outdoor) during today's inspection. The following items were submitted to LPA Yang, including pictures, prior to today's inspection.

1) Updated sketch LIC 999A (Backyard) with updated on and off limit areas
2) Updated LIC 279 application with updated contact number for Applicant and adults living in the home
3) TB test results for four renters residing in the home
4) Updated lease agreement, listing Applicant as the "tenant" of the residence
5) Left side section of backyard has been cleaned of debris & materials

Exit interview conducted and report was reviewed with the Applicant, Caixia Lai. LPAs advised the Applicant that approval of a Large Family Child Care Home license is contingent on Licensing Program Manager's review and final approval.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 1