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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417295
Report Date: 10/11/2022
Date Signed: 10/11/2022 11:24:58 AM

Document Has Been Signed on 10/11/2022 11:24 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LO, HUI FENFACILITY NUMBER:
434417295
ADMINISTRATOR:LO, HUI FENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 588-7369
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
10/11/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Hui Fen LoTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Oscar Huang conducted an announced, scheduled Pre-Licensing inspection at 1236 Manet Drive, Sunnyvale, CA 94087. LPA met with Applicant Hui Fen Lo. Applicant is applying for a license to operate a Small Family Child Care Home with a maximum capacity of eight at the address listed above. LPA observed 2 infants (twin) during the time of visit. The applicant leases the house . The lease agreement, the property owner/landlord consent are on file.

Smoke and carbon monoxide detectors were tested and proved to be functioning. The home’s disaster plan of action was discussed along with the requirement for the home to conduct and document fire and disaster drills at least once every six months. LPA reminded Applicant that smoking is not allowed in family childcare homes and baby walkers shall not be allowed on the premises of the family childcare home in accordance with Health and Safety Code Section 1596.846(b) and (c).

Days and hours of operation will be Monday through Sunday 8AM to 6PM. Applicant has documented proof of immunity against Measles, Pertussis and a statement for not taking Influenza this year, as well as proof of cleared Tuberculosis within 12 months. The applicant's certification of completion of the AB1207 Mandated Reporter Training exp 8/29/24. Her Pediatric CPR & First Aid certification are also current exp 8/24, & completed the 8 hours Preventive Health & Safety Training on 09/11/22. The applicant and has Clearances for Criminal Record and Child Abuse Index Background Check.

LPA reminded Applicant about the applicable civil penalties for those adults who have not received fingerprint clearances, who are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LO, HUI FEN
FACILITY NUMBER: 434417295
VISIT DATE: 10/11/2022
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LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are bedroom (master)#3, bathroom #2 (master), Laundry and garage. The home is with a fully fence in backyard and will be use for outdoor activity. Off limit area in the back yard is gated right side where storage shed is in to ensure inaccessible to children. LPA observed appropriate children’s play structure and toys. Applicant states she will be supervising the children while they participate in all outdoor activities. No Bodies of water observed.

The home is clean and orderly, with heating and ventilation for safety and comfort of children in care. Applicant stated that there are no weapons such as firearm stored on the premises. Detergents, cleaning compounds, sharps, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible, out of reach of children. The home has a fireplace with a fireplace a secured fireplace barrier. LPA reminded Applicant that poisons need to be locked.

Applicant stated that the form of discipline to be used are talking and redirecting the children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Applicants stated that she understands that the children have personal rights that cannot be waived or abridged regardless of consent or authorization from the child’s authorized representative.

LPA went over the records that need to be maintained at the home with Applicant.
Applicant is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.
LPA informed Applicant that if she decides to not carry liability insurance for the Family Day Care, she will have to maintain in children’s file an affidavit regarding liability insurance signed by each parent of the children that will be enrolled. LPA reviewed with Applicant the violations that would result in an immediate assessment of civil penalty in the amount of $500.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LO, HUI FEN
FACILITY NUMBER: 434417295
VISIT DATE: 10/11/2022
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LPA also discussed with Applicant about the continuing requirements, which include but are not limited to the following topics: (1) Separating sick children when they show signs of illness; (2) Supervision of Children; (3) Capacity Options; (4) transportation of children; (5) Procedures for Reporting Suspected Child Abuse and Unusual Incidents/Injuries;
LPA reviewed with applicant, the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.
LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
LPA also informed the Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant Hui Fen Lo.

Based on today's inspection, LPA determined that the home is in compliance with applicable Health & Safety Code and Title 22 Regulations. and
Therefore, Applicant was informed that Applicant's file will be submitted to Licensing Management for final review and approval.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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