434417375-11-2-2023-07-CC-SCHN-CX7QUA-20231102122824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417375
Report Date: 11/02/2023
Date Signed: 11/02/2023 12:28:33 PM

Document Has Been Signed on 11/02/2023 12:28 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:	ZHANG, PEIMING		FACILITY NUMBER:	434417375
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/02/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Peiming Zhang		TIME COMPLETED:	12:50 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Oscar Huang and Sheena Chin conducted a scheduled Pre-Licensing visit. LPAs met with the applicant, Peiming Zhang. The applicant submitted an application for a small Family Day Care on 09 / 13 / 2023. The facility will operate from 8:30am to 6pm Monday through Friday, and serve children from 6 months to 5 years of age.

Observations
The applicant and LPAs toured inside and outside of the facility. The facility is a one-story house. Off limits are bedroom #2 & 3, garage, storage room and part of the back yard. Fully charged fire extinguisher, 3A40BC, was placed in the garage. LPAs discussed with the applicant that the fire extinguisher needs to be fully charged or replaced with a new one.
The fireplace was covered. Smoke/carbon monoxide detectors were working properly in the facility. Cleaning supplies were observed under the sink in the bathroom and the kitchen. LPAs did not observe any mats or cribs in the facility. There were a few toys. LPA advised the licensee to use the website of the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ for recalls for their purchases.
There were no baby walkers observed during today's inspection. Applicant understands that baby walkers and smoking are prohibited in the facility.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ZHANG, PEIMING	FACILITY NUMBER: 434417375
	VISIT DATE: 11/02/2023

NARRATIVE

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Required Documents
The applicant has completed Pediatric First Aid/CPR (expires on August/ 2025), Preventative Health and Safety Training( completed 09 / 26 / 2023 ), Mandated Reporter Training Certificate (completed on 09/27/2023).
The applicant has proofs of immunizations against pertussis, measles and influenza on file.

The applicant stated that adults residing at this facility include the licensee, her brother and her sister-in-law. A review of staff records indicate that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The 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.
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The applicant leased the property and provided the lease agreement as a proof of control of the property. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

The applicant stated that she will purchase liability insurance, and understood that if she does not provide it, she needs to have each parent sign LIC282, affidavit regarding liability insurance for family child care home.

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. Entrance Checklist was provided to the applicant.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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: ZHANG, PEIMING	FACILITY NUMBER: 434417375
	VISIT DATE: 11/02/2023

NARRATIVE

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Discussions
The applicant understood that children's personal rights should not be violated, including no corporal punishment. LPAs discussed with the applicant about isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries.
LPAs informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPAs discussed the safe sleep regulations with the applicant and provided a Sudden Infant Death Syndrome (SIDS) flyer to the applicant. The LPAs 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. LPAs 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.

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) or (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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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: ZHANG, PEIMING	FACILITY NUMBER: 434417375
	VISIT DATE: 11/02/2023

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Information
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
The 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&Rs) throughout California.
On this date, 09 / 14 / 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.

Exit interview was conducted and the report was discussed and verbally translated into Chinese with applicant, Peiming Zhang. LPAs advised the applicant that her small family child care home license is pending upon management review/approval and submitting the following items to the office.
1. Send the receipts and photos for the purchases of sleeping mats/cribs.
2. Send photos, showing that drawers and cabinets were safely locked in the bathroom and kitchen. Or send photos, showing that hazardous materials are not accessible to children in care.
3. Send the photo of the installed gate in the sandbox area in the back yard.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC809 (FAS) - (06/04)

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