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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416832
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:40:40 PM

Document Has Been Signed on 11/16/2023 01:40 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:CHANG, CHAO-JUNGFACILITY NUMBER:
434416832
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Chao-Jung ChangTIME COMPLETED:
01:55 PM
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On November 16, 2023 at 12:37 PM, Licensing Program Analyst (LPA) Marilou Monico, made an unannounced Case Management Inspection in response to a request to increase the capacity. LPA met with Licensee, Chao-Jung Chang, and explained the purpose of today's visit. Also present in the home were licensee's adult assistant (S1) and five (5) daycare children including three (3) infants and two (2) preschool age. The home is a one storey with three bedrooms and two baths and an attached Accessory Dwelling Unit (ADU) with one bedroom and one bath. Licensee states that there are three adults residing in the home: herself, her husband, and one other adult residing in the ADU. Fire clearance was granted on November 13, 2023.

Licensee states that the daycare is open Monday - Friday from 8:30 AM to 6:00 PM. Licensee has completed the Preventative Health and Safety Training including Nutrition and Lead Poisoning Prevention and a copy of the certification is on file. Licensee's CPR and First Aid certifications are current and expire on November 4, 2025. LPA discussed and provided Licensee a copy of the ratio and capacity chart. Licensee provided LPA a copy of Property Owner/Landlord Consent form (LIC 9149) during the inspection. LPA obtained a copy of children's roster.

LPA inspected the indoor and outdoor areas of the home. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors, gated kitchen, and covered fireplace. Off limit areas inside the home are: kitchen, master bedroom, master bathroom, laundry room, and ADU Unit. Off limit areas outside the home: barricaded area of the left side yard and locked storage shed in the backyard. Cleaning products, sharp objects, and other similar items are stored inaccessible to children. LPA observed sufficient toys, supplies, and equipment for the day care children. Licensee states that there are no weapons in the home. There were no bodies of water observed.

As a result of this inspection, a license for a Large Family Child Care Home is approved effective today, November 16, 2023.

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: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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