434416716-4-10-2023-07-CC-MMOO-CQRTQY-20230410145645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416716
Report Date: 04/10/2023
Date Signed: 04/10/2023 02:59:55 PM

Document Has Been Signed on 04/10/2023 02:59 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ZHANG, SIJIA		FACILITY NUMBER:	434416716
ADMINISTRATOR:	ZHANG, SIJIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 981-4915
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 10	DATE:	04/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Sijia Zhang		TIME COMPLETED:	03:10 PM

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	Licensing Program Analyst (LPA), Marilou Monico conducted a Required - 1 Year Inspection. LPA met with Licensee, Sijia Zhang, and explained to her the nature of today's visit. Also present in the home were licensee's two adult helpers and 10 daycare children including three (3) infants and seven (7) preschool age. All required posted materials were posted by the front entrance. The daycare is open Monday thru Friday from 8:00 AM to 6:00 PM. There are no active waivers or exceptions for this facility. The daycare is a one storey home with three bedrooms and 2 bathrooms. Per Licensee, the adults that reside in the home are herself, her husband, and her mom. Licensee states that her two children ages 7 and 5 years old also live in the home. LPA observed a current children's roster (LIC9040). Copy of children's roster was obtained during the inspection. Fire/disaster drill was conducted on December 1, 2022. LPA observed a fully charged 2A10BC fire extinguisher, functioning smoke and carbon monoxide detectors, and glass covered fireplace. Licensee states that there are no weapons or firearms in the home. Incidental Medical Services (IMS) policy was discussed. Licensee states that she is not planning to administer any medication at this time. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes, Section 102417. 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 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: http://www.ada.gov/childqanda.htm LPA reminded licensee that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Continuation on next page:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ZHANG, SIJIA	FACILITY NUMBER: 434416716
	VISIT DATE: 04/10/2023

NARRATIVE

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Off limit areas in the home: 2 bedrooms, dining room, kitchen, one bathroom, screen room, and garage LPA observed that the home is clean and orderly. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (408) 981-4915. Licensee states that there are no off limit areas outside the home. No bodies of water were observed.

LPA reviewed 10 children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286).

LPA reviewed two helper's files for the following records: Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights, required immunizations and TB test. Licensee's Mandated Reporter Training expires on April 13, 2023. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. LIcensee has immunization in Measles, Pertussis, and Influenza. Licensee and her helpers have current Pediatric CPR/First Aid certifications.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Exit interview conducted and report was reviewed with Sijia Zhang, Licensee.

As a result of today's inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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