434417348-6-22-2023-07-CC-YHUG-CT2TU3-20230622150140

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417348
Report Date: 06/22/2023
Date Signed: 06/22/2023 03:01:48 PM

Document Has Been Signed on 06/22/2023 03:01 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:	LI, GAO LAN		FACILITY NUMBER:	434417348
ADMINISTRATOR:	LI, GAO LAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 505-6292
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94085
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/22/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Gao Lan Li		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) Oscar Huang conducted an announced, scheduled Pre-Licensing inspection in response to applicant, Gao Lan Li relocation request at 748 Borregas Ave., Sunnyvale, CA 94085. Applicant currently has a large FCCH license (#434416485) located at 749 Carolina Ave., Sunnyvale, CA 94085. LPA explained the nature of today’s inspection to Applicant. Present is applicant only. The adults live in the home will be Applicant and her tenant. Applicant leases the house, the lease agreement & the property owner/landlord notification are on file. Smoke and carbon monoxide 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 Friday 8:30AM to 6:00PM. Applicant has documented proof of immunity against Measles, Pertussis, and Influenza this season, as well as proof of cleared Tuberculosis. The applicant's certification of completion of the AB1207 Mandated Reporter Training exp 5/22/2022. His Pediatric CPR & First Aid certifications are also current exp 11/2022, & completed the 8 hours Preventive Health & Safety Training on 06/13/2021. The applicant and her tenant had clearances for Criminal Record and Child Abuse Index Background Check, and the tenant has a proof of cleared Tuberculosis within 12 month.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: LI, GAO LAN	FACILITY NUMBER: 434417348
	VISIT DATE: 06/22/2023

NARRATIVE

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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 inspected the indoor and outdoor areas of the home. Off limits areas in the home are bedroom #1 & #2, bathroom #, and garage. The home is with a fully fence in backyard and will be use for outdoor activity. Off limit area in the back yard is both sides beyond fences to ensure inaccessible to children. LPA observed appropriate children’s play structure and toys. Applicant states he 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 blocked 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. Applicant stated that he 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 informed Applicant that if he decides to not carry liability insurance for the Family Day Care, he will have to maintain in children’s file with an affidavit regarding liability insurance signed by each parent of the children that will be enrolled.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: LI, GAO LAN	FACILITY NUMBER: 434417348
	VISIT DATE: 06/22/2023

NARRATIVE

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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.

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 webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

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: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: LI, GAO LAN	FACILITY NUMBER: 434417348
	VISIT DATE: 06/22/2023

NARRATIVE

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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/.

Applicant 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.

A fire clearance granted from the Sunnyvale Fire Department was received on 6/21/2023: No violations found, fire clearance granted. Daycare use is approved for the following areas: backyard, kitchen, dinning area, living room, bedrooms #3 & Bathroom #2. No children in garage, bedroom 1& 2 and bathroom 1.

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.

During the exit interview, the Applicant/Licensee Gao Lan Li confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
The report was discussed and verbally translated into Chinese during the exit interview with Applicant Goa Lan Li. 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 final review & approval:
1: An updated Emergency Disaster Plan for Family Child Care Homes to include a relocation site with owner's permission.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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