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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417316
Report Date: 02/05/2024
Date Signed: 02/05/2024 04:26:23 PM

Document Has Been Signed on 02/05/2024 04:26 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:WANG, QINGMINFACILITY NUMBER:
434417316
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
02/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Qingmin WangTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Oscar Huang met with licensee, Qingmin Wang for an unannounced case management to the facility in regards to a deficiency that was cited on 1/25/2024 for missing parents signed documents of daycare children's Affidavit Regarding Liability Insurance. LPA explained the nature of today’s inspection to her. Present were an assistant, 2 infants & 4 preschoolers during today's inspection.

Licensee submitted her liability insurance proof/certificate to the office on 2/1/2024 which shows the facility has purchased the insurance since 4/1/2023 with coverage up to 12 children in care at one time. As such, the cited deficiency on 1/25/2024 is therefore void. An amend on LIC809-C & LIC809-D dated on 1/25/204 was created and an amend statement were added to the narrative of 809-C & Plan of Correction of 809-D.

No deficiency was cited. A notice of site visit was given and must remain posted for 30 days. The report was discussed and verbally translated into Chinese during the exit interview with licensee, Qingmin Wang.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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