434417327-4-6-2023-07-CC-YHUG-CQMNSV-20230406104347

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417327
Report Date: 04/06/2023
Date Signed: 04/06/2023 10:45:23 AM

Document Has Been Signed on 04/06/2023 10:45 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:	ZHOU, JINYUN		FACILITY NUMBER:	434417327
ADMINISTRATOR:	ZHOU, JINYUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 480-6115
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94085
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	JinYun Zhou		TIME COMPLETED:	11:05 AM

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) Oscar Huang conducted an announced, scheduled Pre-Licensing inspection in response to applicant, JinYun Zhou'ss relocation request at 768 San Ramon Ave., Sunnyvale, CA 94085. Applicant currently has a large FCCH license (#434413572) located at 937 Amadar Ave., Sunnyvale, CA 94085. LPA explained the nature of today’s inspection to Applicant, JInYun Zhou. Present is applicant only. The adults live in the home will be Applicant and her husband. Applicant leases the house from her daughter, the lease agreement & the property owner/landlord notification & consent are on file. LPA reminded applicant that her under 10 years old daughter will be accounted for her capacility when present during her opertion hours. A carbon monoxide detector and smoke 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 Monday 8:30AM to 6:00PM. Applicant has documented proof of immunity against Measles, Pertussis, Tuberculosis, and a Influenza this year, Applicant and her husband requested to be waived for mandated reporter training as their primary language is Chinese. She and her husband's Pediatric CPR & First Aid certifications are also current exp. 7/2023. Applicant has certification for 8 hours Preventative Health and Safety on 03/18/2017, as well as Lead Poisoning Prevention on 08/01/2021. Both applicant and her husband have Clearances for Criminal Record and Child Abuse Index Background Check.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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 4

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: ZHOU, JINYUN	FACILITY NUMBER: 434417327
	VISIT DATE: 04/06/2023

NARRATIVE

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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.

LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are all area in second floor, bathroom#2, kitchen, and garage in first floor. The home is with a fully fence in backyard and will be use for outdoor activity. Off limit area in the back yard is sides beyond gated fence 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 no fireplace. 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: ZHOU, JINYUN	FACILITY NUMBER: 434417327
	VISIT DATE: 04/06/2023

NARRATIVE

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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 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.

A fire clearance granted from the Sunnyvale Fire Department was received on 4/3/2023: Garage and second floor are not approved for daycare use. There were no violations found, fire clearance has been granted.

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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ZHOU, JINYUN	FACILITY NUMBER: 434417327
	VISIT DATE: 04/06/2023

NARRATIVE

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Based on today's inspection, LPA advised applicant that a large Family Child Care Home license will be approved pending on receiving the following document and the management approval:

1. Updated Application For a Family Child Care Home License (LIC 279) to correct address on item 6.

This report was discussed and verbally translated into Chinese during the exit interview with Applicant, JinYun Zhou.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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