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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417375
Report Date: 06/18/2025
Date Signed: 06/18/2025 01:40:31 PM

Document Has Been Signed on 06/18/2025 01:40 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, PEIMINGFACILITY NUMBER:
434417375
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
06/18/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Zhang, Peiming TIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On 06/18/2025, Licensing Program Manager (LPM) Gladys Kuizon and Licensing Program Analyst (LPA) Kate Huang met with Licensee, Zhang, Peiming and her sister-in law, Liu, Fan for a scheduled Informal Meeting at the San Jose Regional Office. The purpose of the Informal Meeting was to discuss recent citations issued on 01/23/2025 and 05/23/2025.

01/23/2025’s visit:

Background Check Violation: Upon arrival, LPA observed that Peiming Zhang’s husband was present at the facility, and he did not have fingerprint clearance.

Safe Sleep Violation:

During the inspection, three infants were present; however, none of them had 15-minute sleep check logs.

Violation of Alteration to Existing Building or Grounds:

LPA observed one infant sleeping in a bedroom which is"off-limits".

Children’s Records Violation: During the visit, the licensee was unable to provide all the required records for the three infants present.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Linke Huang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 06/18/2025
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05/23/2025’s visit:

Although citations were issued and guidance was provided by LPA in January 2025,, during a case management inspection conducted by LPA Huang on 05/23/2025, additional violation were cited.

Type A Citation – Personal Rights Violation:

At 12:45 PM, LPA observed an infant lying in a bouncer, unstrapped, positioned in the yard just outside the daycare room. At the time, the licensee was seated behind the infant, engaged in a phone conversation.

Children’s Records Violation:

LPA reviewed the records of all three enrolled children. One file was missing the LIC 627 (Consent for Emergency Medical Treatment), another was missing the LIC 9224 (Acknowledgment of Receipt of Licensing Reports), and the third file was missing the LIC 282 (Physician’s Report).

Dangerous Items Accessible to Children:

LPA observed that numerous bottles of shampoo, conditioner, and similar items were accessible to children in the children's bathroom.

On 06/18/2025 during the Informal Meeting, all Type A and Type B citations issued on 01/23/2025 and 05/23/2025 were discussed with the Licensee.

Licensing Program Manager, Gladys Kuizon explained to Licensee the seriousness of these violations and that if there is continued non-compliance, the day care home may be referred to the Legal Department for possible administrative action, which could include revocation of the day care license. The day care home will be monitored more frequently to ensure that Licensee is operating in compliance with all applicable laws and regulations.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Linke Huang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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: 06/18/2025
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During today's meeting, LPM Kuizon and LPA Huang discussed the requirements for personnel and adult residents, as well as the necessary documents for children's enrollment. They also reviewed infant safe sleep regulations. LPM Kuizon and LPA Huang showed to the licensee how to access the regulations on the CDSS website (https://www.cdss.ca.gov/) and provided the R&R website (https://rrnetwork.org/) as a resource. Additionally, they discussed the Technical Support Program Training with the licensee and provided the following documents: Capacity Regulation flyer, PUB 394, LIC 9224, LIC 282, LIC 700, LIC 627, LIC 995A, LIC 9052, LIC 9108, LIC 311D, LIC 9227, the Infant Safe Sleep PIN, and the Updated Guardian & Background Check Best Practices PIN.

During the meeting, the licensee confirmed that they have understood all the regulations and requirements we discussed today. Licensee's change of capacity application is on hold pending management review.

LPM Kuizon also discussed the requirements of AB 633 with Licensee and provided her with the AB 633 fact sheet and a copy of LIC9224 "Acknowledgement of Receipt of Licensing Reports."

This report was explained with Licensee in Mandarin and a copy was provided to Licensee at the conclusion of the Informal.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Linke Huang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
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