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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417021
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:26:46 PM

Document Has Been Signed on 04/11/2024 02:26 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:KIM, JIAEFACILITY NUMBER:
434417021
ADMINISTRATOR/
DIRECTOR:		JIAE KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 503-8542
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Jiae KimTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Jiae Kim, Licensee, for an unannounced case management inspection. LPA observed three adult assistants (Mi Young Hong, Yong Kyo Cho, and Daisy Santoyo) and twelve napping children (1 infant & 11 preschool) in the home.

LPA reviewed three staff files during today's inspection. LPA advised Jiae that she will need to apply for a separate Child Care Center License if she elects to expand beyond her current large Family Child Care Home license in the future. LPA also advised Jiae that the Department does not allow ownership or financial interest in more than one family child care.

Jiae Kim, Licensee, understands LPA's explanation.

Exit interview conducted and report was reviewed with the Licensee, Jiae Kim. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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