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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417126
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:41:50 AM

Document Has Been Signed on 03/28/2024 10:41 AM - 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: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: 10CENSUS: 4DATE:
03/28/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sepideh Sotoudeh and Zenggiang WangTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Mandeep Kaur and Mel Matos met with Site Director, Sepideh Sotoudeh and Licensee Representaive, Zenggiang Wang, for an unannounced Plan of Correction (POC) inspection. Purpose of today's inspection: address the Plan of Correction (POC) for a "Type A" deficiency issued to the Facility on March 20, 2024. LPAs toured the Facility and observed two staff, Adrianna Apostolo and Sunethra Rammandala, with four day care children in Room 1(Mercury).

Licensee Representative submitted a written Plan of Correction (POC) addressing action taken, including staff schedule, to ensure that the director or fully qualified teacher are the individuals that open or close the Facility to LPAs during today's inspection addressing the violation listed below:

1) Type A deficiency (Section 101229(a)(1)- Responsibility for Providing Care and Supervision) resulted from a substantiated complaint investigation on March 20, 2024. An unqualified staff (Zengqiang Wang) has provided care and supervision to children in the facility with no director or fully qualified teacher present between 7:30 AM-8:00 AM on numerous occasions. This Presents an immediate risk to the health, safety or personal rights of children in care.

It is concluded that the Licensee Representative has completed the Plan of Correction for the deficiency listed above and the deficiency is thus cleared as of today, March 28, 2024.

Exit interview conducted and report was reviewed with the Licensee Representative and Site Director. No deficiencies issued during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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