434417313-1-18-2023-07-CC-SCOS-CN83D9-20230118170910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417313
Report Date: 01/13/2023
Date Signed: 01/18/2023 05:09:17 PM

Document Has Been Signed on 01/18/2023 05:09 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MA, YUSHU		FACILITY NUMBER:	434417313
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/13/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Ma Yushu		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Page 1 Licensing Program Analyst (LPA’s) Stephanie Collins conducted an announced, scheduled Pre-Licensing inspection of 2708 Lucena Dr. San Jose Ca. 95132 met with Applicant Yushu Ma and daughter Meiying Li , 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. A copy of the control of property is on file. LPA observed that the home has a fully charged fire extinguisher functioning smoke and carbon monoxide detectors. 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 Child Care Homes and baby walkers cannot be used for children in care and need to be kept inaccessible. Days and hours of operation will be Monday through Friday 8:30 AM to 6:00 PM. Applicant has completed 16 hours of training on preventive health practices, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition. Applicant's Pediatric and CPR certification expires 5/2023. Applicant has documented proof of immunity against Measles and Pertussis. Applicant's Certification of Completion of the AB1207 Mandated Reporter Training expires 7/12/2023. Adults who are over the age of 18 and reside in the home are the Applicant and Applicant's Spouse ( Lianxi Li) their daughter (Meiying Li) and son-in law (Shunyi Zhao). All have 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: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MA, YUSHU	FACILITY NUMBER: 434417313
	VISIT DATE: 01/13/2023

NARRATIVE

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LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are the kitchen and dining-room, Family-room, stairs case, downstairs bedroom and garage. The back yard is fenced and will be used for outdoor activity. Off limit area in back yard; sides of house in and around storage shield with lock. No open 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. The home does not have any pets. 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. 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 via LIC 311. 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 the children’s file an affidavits regarding liability insurance the form is be 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.

PA also discussed with the 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; (6) Safe Sleep; and (7) Healthy Beverages in Child Care.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MA, YUSHU	FACILITY NUMBER: 434417313
	VISIT DATE: 01/13/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

Exit interview was conducted, where this report was reviewed with Applicant Ma Yushu and Meiyng Li,

Therefore, Applicant was informed that Applicant's file will be submitted to Licensing Management for final review and approval of all required documents.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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