434417355-1-31-2024-07-CC-SYIP-CZZV83-20240131151204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417355
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:12:17 PM

Document Has Been Signed on 01/31/2024 03:12 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SUN, HAIYAN		FACILITY NUMBER:	434417355
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 4	CENSUS: 4	DATE:	01/31/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Haiyan Sun and Valeriya Androsenko		TIME COMPLETED:	01:50 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Annual/Random inspection. LPA met with Licensee Haiyan Sun and Valeriya Androsenko, assistant, and explained the reason for the inspection. Licensee also applied for a change of capacity from a small Family Child Care Home (FCCH) to a large FCCH. Licensee has at least one year of experience working at a child care center to apply for a large FCCH. A fire clearance was granted on 01/29/2024. Present during today's inspection were Licensee, her assistant, and four children, whom three were infant age. All adults present have cleared fingerprints. There is a board to post required postings, such as license and notification of parent's rights. The hours of operation are Monday through Friday 8AM to 5PM. Licensee does have liability insurance. LPA toured the home with Assistant, Valeriya. The off-limit areas of the home are Bedroom 3, Bedroom 4, bathroom located in Bedroom 3, and the kitchen. There is a fireplace in the home, which has a netted fence surrounding it. There are toys and equipment for children. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire drill was conducted on 01/25/2024. Valeriya stated that there are no weapons, firearms, stored in the home. ------------------CONTINUES ON 809 DATED 01/31/2024 PAGE 2----------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SUN, HAIYAN	FACILITY NUMBER: 434417355
	VISIT DATE: 01/31/2024

NARRATIVE

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-------------CONTINUATION OF 809 DATED 01/31/2024 PAGE 1-------------

The backyard is used and is fenced. The off-limit area outside is the shed. There are equipment for children. LPA observed that there was a climbing structure that was not anchored to the ground. Licensee stated that she will anchor it to the ground and send proof to Licensing. There were no bodies of water observed during today's inspection.

LPA discussed the safe sleep regulations with licensee and assistant 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 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. LPA discussed` with assistant that the door where infants are sleeping needs to remain open and they need to be able to see infant without having to move the door. LPA discussed that there cannot be anything hanging on the crib and nothing attached to the pacifiers. LPA observed that an infant was going down for a nap. Assistant was standing next to the crib at the time. There was a blanket hanging on the side of the crib and infant had a leash attach to her pacifier. Assistant removed blanket hanging on the side of the crib during today's inspection and used a different pacifier that does not have a leash.

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/.

Valeriya stated that they do not transport children, but understands that children cannot be left alone and unattended in parked vehicles. LPA also reminded Valeriya that all containers of food brought from home need to have the child's name on it.

-------------CONTINUATION OF 809 DATED 01/31/2024 PAGE 3----------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SUN, HAIYAN	FACILITY NUMBER: 434417355
	VISIT DATE: 01/31/2024

NARRATIVE

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------------CONTINUATION OF 809 DATED 01/31/2024 PAGE 2-------------

A copy of the facility roster was obtained. Four (4) children files were reviewed during today's inspection. The records reviewed include but not limited to parent's rights. LPA also reviewed sleep log. LPA discussed with Valeriya that forms are filled out completely and correctly.

Licensee and her assistant have immunization records for pertussis, measles, and influenza on file. Licensee and assistant both completed Mandated Reporter training. Licensee completed training on 07/14/2022 and her assistant completed training on 04/10/2023. LPA reminded Licensee that Mandated Reporter training requires renewal every two years. Licensee has a valid CPR/1st, which expires on 11/2025.

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

LPA reminded Licensee that when Licensee does not have an assistant, Licensee can only care for up to 6 children at any one time in the home.

------------CONTINUATION OF 809 DATED 01/31/2024 PAGE 4------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SUN, HAIYAN	FACILITY NUMBER: 434417355
	VISIT DATE: 01/31/2024

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------------CONTINUATION OF 809 DATED 01/31/2024 PAGE 3----------------

The licensee provided proof of control of property. The licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

Licensee is the only adult over 18 living in the home. 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.

During the exit interview, the Licensee Haiyan Sun, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee will submit the following:
- proof that climbing structure is anchored by 02/09/2024

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee Haiyan Sun and Assistant Valer. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/31/2024 03:12 PM - It Cannot Be Edited

Created By: Samantha Yip On 01/31/2024 at 01:19 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SUN, HAIYAN	FACILITY NUMBER: 434417355
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)(1)(A)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care. LPA observed that there was a leash attached to the pacifier.
	POC Due Date: 02/01/2024
	Plan of Correction
1 2 3 4	Deficiency corrected during today's inspection. Assistant removed pacifier and used a different pacifier that does not have the leash attached.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Joel Segura

LICENSING EVALUATOR NAME:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC809 (FAS) - (06/04)

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