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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416585
Report Date: 12/17/2024
Date Signed: 12/17/2024 01:21:15 PM

Document Has Been Signed on 12/17/2024 01:21 PM - 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: 14CENSUS: 0DATE:
12/17/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Caixia LaiTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Manager (LPM) Belinda Devall, Licensing Program Analysts (LPA) Andy Yang and Mel Matos from the San Jose Regional Office and LPM Jason Jang and LPA Manel Estoesta from the Oakland Southeast Regional Office met with licensee Caixia Lai for an ANNOUNCED OFFICE VISIT regarding the pending change of location application. Present with the licensee is her daughter, Sandy Lai, licensee of her own Family Child Care Home license which is separate from licensee Caixia Lai. Sandy Lai license is under the Regional Office of Oakland Southeast.

The purpose of this meeting was to discuss the application for initial license for a Family Child Care Home, the expectation of the licensee to comply with all regulations and laws governing over Family Child Care Homes, and the scope of operation with the duly authorized officer, employee, or agent of the Department.

As the licensee, you are the adult licensed to operate a Family Day Care Home and who is primarily involved in providing care for the children during the operating hours that the home provides care and is responsible to ensure compliance. Licensee, Caixia Lai must work with the duly authorized officer, employee, or agent of the Department, and any substitute provider must know the laws and regulations when the licensee is away.

Licensee is aware that they cannot operate without a license. If the licensee moves and wants to apply for a license, they may not operate providing care and supervision which requires a license. The licensee, Caixia Lai, acknowledges and agrees that she is responsible for compliance of the family child care home and will be the point of contact when interacting with the duly authorized officer, employee, or agent of the Department.

The Family Child Care Home is ready for licensure effective December 17, 2024.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Andy Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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