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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417368
Report Date: 09/19/2023
Date Signed: 09/21/2023 08:17:58 PM

Document Has Been Signed on 09/21/2023 08:17 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, LINFACILITY NUMBER:
434417368
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:LIn ChenTIME COMPLETED:
12:30 PM
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Licensing Program Analysts(LPA's) Anna Morales and Sheena Chin conducted a scheduled Pre-Licensing visit. LPA's were greeted by Applicant Lin Chen and her mother. Applicant submitted an Application for a Small Family Day Care. Hours of operation will be 8:00am-6:00pm, ages 0 months -4 years of age.

Applicant has completed Pediatric first aid/CPR (expires on 8/5/2025), Preventative Health and Safety Training( completed 7/4/2023). Applicant has immunization against pertussis, measles and influenza on file.

Applicant provided proof of control of property. Applicant stated that she will provide liability insurance, and understands that if she does not provide it, she will issue affidavit regarding liability insurance for FCCH to the parents.
Applicant stated that she, her husband and both of her parents are the only Adults residing at this location. A review of staff records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHEN, LIN
FACILITY NUMBER: 434417368
VISIT DATE: 09/19/2023
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There were no baby walkers observed during today's inspection. Applicant understands that baby walkers and smoking is not permitted in the home. There a fully charged fire extinguisher and working carbon monoxide/smoke detectors. LPA's discussed with Applicant that fire extinguisher need to be serviced every year or obtain a new fire extinguisher.

LPA's observed toured the inside and outside of the Family Day Care. The house is a single story house There is a covered fire place inside the day care room. Off limits inside the home, the kitchen, Bedrooms #2, 3, and 4/bathroom. Children will have access to the front living room/dining area(day care rooms), Family room, hallway bathroom and bedroom #1. Off limits outside the home, is the garage and the right side of the house. Applicant has two chickens as pets who will be kept separate from the children. Applicant stated that they don't have any weapons on site.

Applicant understands that children's personal rights should not be violated; including no corporal punishment. isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.
LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA provided 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's discussed the safe sleep regulations with Applicant. LPA's discussed the safe sleep regulations with licensee [or facility representative] and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA's 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHEN, LIN
FACILITY NUMBER: 434417368
VISIT DATE: 09/19/2023
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On this date, 8/9/2023, The California Attorney General- Megan's Law Website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R & R) throughout California.

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.

During the exit interview, the Applicant Lin Chen confirmed that there are no Registered Sex Offenders living in the facility and LPA's completed the RSO profile in FAS

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHEN, LIN
FACILITY NUMBER: 434417368
VISIT DATE: 09/19/2023
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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: http://www.ada.gov/childqanda.htm


Prior to Licensure, LPA's are recommending Applicant to complete the following:

1. Place covers on each of the electrical outlets in the day care, family room and Bedroom #1.
2. Remove or bolt the piano inside the Day care room
3. Ensure that the smoke detector is working in the hallway, close to bedroom Number One.
4. Safety locks inside the kitchen cabinet(underneath sink) and the cabinet inside Bathroom Number 1.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
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