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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417126
Report Date: 03/20/2024
Date Signed: 03/20/2024 04:01:22 PM

Document Has Been Signed on 03/20/2024 04:01 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:JY INTERNATIONAL GROUPFACILITY NUMBER:
434417126
ADMINISTRATOR:THERESA CAMPBELLFACILITY TYPE:
850
ADDRESS:755 SOUTH BERNARDO AVENUETELEPHONE:
(408) 348-9618
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 120TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
03/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Zengqiang WangTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Mel Matos and Mandeep Kaur, met with Zengqiang Wang, Licensee representative, for an unannounced case management inspection. LPAs explained the purpose of today's inspection to Zengqiang Wang.

Purpose of today's inspection: provide an "amended" signed copy of a licensing report.

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

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

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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