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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417356
Report Date: 10/11/2024
Date Signed: 10/11/2024 04:32:20 PM

Document Has Been Signed on 10/11/2024 04:32 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:CHEN, SIXINFACILITY NUMBER:
434417356
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
10/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Sixin ChenTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Mel Matos and Syhshyan "Shine" Yu met with Sixin Chen, Licensee, for an unannounced Annual/Random inspection and capacity increase request. LPAs were granted access to the home by one of the adult assistants. Licensee was running an errand and arrived at the home approximately 35 minutes later. LPAs also observed two adult assistants and five day care children (2 infants & 3 preschool) in the home during today's inspection. Licensee was operating within their capacity and ratio requirements. Licensee has been licensed as a small Family Child Care Home since August 30, 2023 and thus meet the one year minimum experience requirement to apply for the large Family Child Care Home License. LPAs observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday - Friday from 8:30 AM to 6:00 PM. Licensee is the only adult residing in the home. Licensee states that her two adult tenants moved out on September 1, 2024. There are no minor children residing in the home.

LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on June 20, 2024. Licensee has day care insurance through State National Insurance
Company, Inc and LPAs observed a valid policy (exp: 07/05/25) during today's inspection. Licensee has current CPR and First Aid certifications (exp: 02/25) on file. Licensee's two adult assistants also have valid CPR & First Aid certifications (exp: 11/05/24 & 09/21/26). Licensee and two adult assistants have the required vaccines (MMR, Tdap, & flu - opt out) and are current with the Mandated Reporter Training for Child Care Workers. LPAs reviewed five children's files (2 infant & 3 preschool) and the files were complete with the required forms, including infant sleep logs. LPAs reviewed three staff files (Licensee & two adult assistants) and the files were complete with the required forms. Copy of lease agreement verifying control of property is on file. Property Owner/Landlord Notification (LIC 9151) and a signed Property Owner/Landlord Consent (LIC 9149) forms are on file.

LPAs toured the indoor and outdoor areas of the home with the Licensees during today's inspection. Licensee has a working telephone in the home. The home is clean, orderly, (including heating/air conditioning/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no stairs inside the home. Licensee has two wall heaters inside the home that are barricaded. Off limit areas inside the home: bedroom 1 & 3, kitchen, barricaded fireplace unit (located in the living room area), bathroom 2, and attached garage. Off limit areas outside the home: front yard, right side area of the backyard.

LPAs observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee states that she does not have any weapons or pets in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee states that there are no poisons in the home.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHEN, SIXIN
FACILITY NUMBER: 434417356
VISIT DATE: 10/11/2024
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Licensee state that she provides all meals (breakfast, snacks, and lunch) to the day care children. Licensee understands that any food/drink brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee states that nobody smokes and they understands that smoking is prohibited in the home.

Licensee do not administer medication to children. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours (80% of the operating hours) and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 8 children present in the home without at least one qualified adult present. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that they do not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Sixin Chen, Licensee, were reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with the Licensee 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. LPAs also informed the 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

LPAs have not received a fire clearance approval from the Sunnyvale Department of Public Safety as of today's inspection.

Exit interview conducted and report was reviewed with the Licensee, Sixin Chen. No deficiencies issued during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days.

A large Family Child Care Home license will be approved upon completion of the following:

1) Fire clearance approval has been received from the Sunnyvale Department of Public Safety

2) Updated Application for a Family Child Care Home (LIC 279) has been received.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
LIC809 (FAS) - (06/04)
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