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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417313
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:07:30 PM

Document Has Been Signed on 01/29/2024 03:07 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:MA, YUSHUFACILITY NUMBER:
434417313
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
01/29/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Yushu MaTIME COMPLETED:
02:30 PM
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On 1/29/24 at 12:30pm, Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced case management for capacity increase. LPA met with the licensee, Ma Yushu and explained the purpose of the inspection. Present were the licensee, her daughter (helper), her son-in-law (helper) and 6 children in care. The licensee submitted the application form (LIC 279) to update the operating hours. The licensee stated that she wanted to operate on Saturdays from 8:30am to 6pm. The current operating hours are from 8:30am to 6pm, Monday through Friday.

LPA observed that required postings were posted. LPA, along with the director toured the inside and outside of the home. LPA observed that 6 more cots were purchased and advised the licensee to carefully arrange the cots so that the walkways are not blocked. The licensee stated that for supervision purpose, she had all 6 children take naps in the family room, but she’ll use the living room as another napping area and have assistants to watch kids sleep in both areas once she gets the large family child care home license. The fire inspection was completed on 1/5/24 for large family child care home license.

Cameras were observed in the living room and family room. The licensee stated that these cameras were for live images, and she did not store the images. LPA advised the licensee about the right of privacy. The licensee stated that parents acknowledged the working cameras.

No deficiencies were cited.



Exit interview conducted and report was reviewed with Yushu Ma. LPAs advised the licensee, Yushu Ma that a license for capacity increase will be approved upon management review and approval. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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