434417377-11-7-2023-07-CC-SCHN-CXCQGL-20231107110944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417377
Report Date: 11/07/2023
Date Signed: 11/07/2023 11:09:57 AM

Document Has Been Signed on 11/07/2023 11:09 AM - 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:	MENG, QINGYI		FACILITY NUMBER:	434417377
ADMINISTRATOR:	MENG, QINGYI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 229-3530
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	11/07/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Qingyi Meng		TIME COMPLETED:	11:30 AM

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	Page 1. Licensing Program Analysts (LPAs) Oscar Huang and Sheena Chin conducted a scheduled Pre-Licensing visit. LPAs met with the applicant Qingyi Meng. The applicant submitted an application for a large Family Day Care on 09 /26 / 2023. The facility will operate from 8:30am to 6pm, Monday through Friday, and serve children from 3 months to 5 years of age. The applicant has two children above 10 years old. The applicant stated that she rented this property for her facility. Observations The applicant and LPAs toured inside and outside of the facility. The facility is a one-story house. Off limits are all three bedrooms, kitchen and garage. Fully charged fire extinguisher, 2A10BC, was placed in the kitchen. 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. LPAs observed that shampoo and conditioner were accessible to children but the applicant put these items in the locked cabinet under the sink during the inspection. Cleaning supplies were observed next to the toilet in the bathroom. The applicant put the items in the locked cabinet during the inspection. LPAs observed 2 fish tanks (40 gallons and 5 gallons), standing alone in the living room. Both of them were covered and inaccessible to children in care. The applicant stated that she will move the little fish tank to the off-limits area, inaccessible to children. The 40-gallon fish tank has less than 10-gallon water. There were a few toys. LPAs 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. continue to page 2.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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: MENG, QINGYI	FACILITY NUMBER: 434417377
	VISIT DATE: 11/07/2023

NARRATIVE

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Required Documents
The applicant has completed Pediatric First Aid/CPR (expires on 04 / 2025 ), Preventative Health and Safety Training( completed 08 / 12 / 2023 ).
The applicant has proofs of immunization against pertussis, measles and influenza on file. The applicant stated that she declined to take a flu shot and provided a written statement.

The applicant stated that she is the only adult residing at this facility. 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.

The applicant has a certificate of mandated reporter training, expired on 07 / 15 / 2025 .
The applicant provided the lease agreement as the proof of control of the property.
The LPAs 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 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 6 [or 12] children.

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.

LPAs discussed with the applicant the 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: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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: MENG, QINGYI	FACILITY NUMBER: 434417377
	VISIT DATE: 11/07/2023

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 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: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC809 (FAS) - (06/04)

Page: 3 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: MENG, QINGYI	FACILITY NUMBER: 434417377
	VISIT DATE: 11/07/2023

NARRATIVE

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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 / 27 / 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.

A fire clearance granted from the San Jose Fire Department was received on 10/31/2023: Fire clearance granted. Home inspection including outdoor areas and garage completed. Approved areas per facility map for up to 14 children for day care use.

Exit interview was conducted and the report was discussed and verbally translated into Chinese with applicant, Qingyi Meng. LPAs advised the applicant that her large family child care home license is pending upon management review and approval.

Prior to Licensure, LPAs advised the applicant to send a photo, showing that the little fish tank was moved from the living room:

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC809 (FAS) - (06/04)

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