434417299-12-19-2024-07-CC-LHUG-DC53S2-20241219172938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417299
Report Date: 12/19/2024
Date Signed: 12/19/2024 05:29:47 PM

Document Has Been Signed on 12/19/2024 05:29 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:	CHEN, XIN		FACILITY NUMBER:	434417299
ADMINISTRATOR/ DIRECTOR:	CHEN, XIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 885-6486
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 11	DATE:	12/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Chen, Xin		TIME VISIT/ INSPECTION COMPLETED:	04:20 PM

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Licensing Program Analyst, Kate Huang met with Licensee, Xin Chen for an unannounced annual inspection as well as licensee capacity increase request. LPA explained the nature of today’s inspection to Licensee. Present were licensee, an assistant, 7 preschoolers and 4 infants during today's inspection. Days and hours of operation are Monday to Friday, 8:30am to 6:00pm. The licensee stated that usually only she resides in the home, but sometimes her husband and children under 10 years old also live here. LPA advised applicant that her two under 10 years children will be accounted for her capacity during her operation hours when present. LPA emphasized the ratio regulation again. Licensee leases the house. The lease agreement, property owner/landlord notification & consent are on file.

LPA toured the indoor and outdoor areas of the home during today's inspection with the licensee. Required materials were observed posted near the entrance. LPA observed sufficient materials, toys, and play equipment for the day care children. The indoor and outdoor areas are all clean and orderly. The home has heating and ventilation for comfort of children.

During nap time, the LPA observed three infants and one preschooler sleeping in a bedroom, each in separate cribs, with an assistant present. Other children were sleeping in the living room on cots. The licensee stated that the infant sleeping on the cot is able to climb out of the crib. The LPA emphasized the infant safe sleeping regulations to the licensee once again.

The LPA observed a fully charged fire extinguisher and functional smoke and carbon monoxide detectors. The licensee confirmed that there are no weapons in the home. All detergents, cleaning compounds, poisons, medications, sharp objects, and similar items were stored out of reach of children. The licensee also understands that smoking is prohibited in the home.

The LPA verified that the licensee holds current CPR and First Aid certification, which expires in October 2025. The LPA observed a current roster of children and a fire and disaster drill log, with drills conducted at least once every six months. The most recent drill was conducted on 07/18/2024. The LPA reviewed six children’s files, including three infant files. All required documents were present in the children’s files. The LPA also reviewed the 15-minute check-in documentation and infant sleep plans. Staff records contained all required documents.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CHEN, XIN	FACILITY NUMBER: 434417299
	VISIT DATE: 12/19/2024

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Licensee stated that she never provided medicine to children. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CHEN, XIN	FACILITY NUMBER: 434417299
	VISIT DATE: 12/19/2024

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During the exit interview, the licensee, Chen, Xin confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

As a result of todays inspection, no deficiency was cited.

A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the licensee, Chen, Xin in Mandarin.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Linke Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

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