434417390-12-21-2023-07-CC-SCHN-CYQUTS-20231221145224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417390
Report Date: 12/21/2023
Date Signed: 12/21/2023 04:04:15 PM

Document Has Been Signed on 12/21/2023 04:04 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:	CHANG, CHEN JUNG		FACILITY NUMBER:	434417390
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/21/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Chen Jung Chang		TIME COMPLETED:	03:45 PM

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 Analyst (LPA) Sheena Chin conducted a scheduled Pre-Licensing visit. LPAs met with the applicant Chen Jung Chang. The applicant submitted an application for a Small Family Day Care on 11/14/23. The facility will operate from 8:30am to 6:00pm Monday through Friday and serve children up to 8 years of age. The applicant stated that she owns this property. The applicant stated that the facility will not accept children with medical needs. LPA advised the applicant that she needs to notify the licensing department if she decides to accept children with medical needs. The property has an Accessory Dwelling Unit (ADU) at 3254 San Juan Avenue, which has an independent access. But there is a gate connected to the two addresses. The applicant stated that she will lock the gate during child care operations. Observations The applicant and LPA toured inside and outside of the facility. The facility is a one-story house. Off limits are bedroom #3, kitchen and garage. Fully charged fire extinguisher, 3A40BC, was placed in the garage. LPA discussed with the applicant that the fire extinguisher needs to be fully charged or replaced with a new one. The home does not have a fireplace. Smoke/carbon monoxide detectors were working properly in the facility. Cleaning supplies were stored under the locked cabinet in the kitchen, inaccessible to children. There were a few toys. The applicant stated that she will purchase more 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 toy purchases. There were no baby walkers observed during today's inspection. Applicant understands that baby walkers and smoking are prohibited in the facility. During the inspection, the construction was going on in the back yard. The applicant stated that she planned to install 250-squre-footage playground mat in the back yard for children’s safety. continue to page 2.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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: CHANG, CHEN JUNG	FACILITY NUMBER: 434417390
	VISIT DATE: 12/21/2023

NARRATIVE

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Page 2.

Required Documents
The applicant has completed Pediatric First Aid/CPR (expires on 3 / 16 / 2024 ), Preventative Health and Safety Training( completed 9 / 24 / 2023 ).
The applicant has proofs of immunization against pertussis, measles. The applicant stated that she declines to have the flu shot.

The applicant stated that adults residing at this facility is only the applicant. 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. 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 11 / 24 / 25.

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 LIC126, 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: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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: CHANG, CHEN JUNG	FACILITY NUMBER: 434417390
	VISIT DATE: 12/21/2023

NARRATIVE

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Page 3.

Discussions
The applicant understood that children's personal rights should not be violated, including no corporal punishment. LPA 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.
LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA 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. LPA also informed 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.

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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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: CHANG, CHEN JUNG	FACILITY NUMBER: 434417390
	VISIT DATE: 12/21/2023

NARRATIVE

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Information
On this date, 11 / 15 / 23 , 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, Chen Jung Chang. LPAs advised the applicant that her small family child care home license is pending upon management review and approval.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

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