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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417390
Report Date: 01/29/2024
Date Signed: 01/29/2024 10:08:26 AM

Document Has Been Signed on 01/29/2024 10:08 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:CHANG, CHEN JUNGFACILITY NUMBER:
434417390
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Chen Jung ChangTIME COMPLETED:
10:30 AM
NARRATIVE
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On 1/29/24 at 9:15am, Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced case management to inspect the completed playground. LPA met with the applicant, Chen Jung Chang and explained the purpose of the inspection.

On 12/21/23, LPA conducted an announced pre-licensing inspection, where 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.

During today’s inspection, the 250-square-footage play mat was installed completely in the 400-square-footage back yard. LPA observed that there were no shades in the back yard. The applicant stated that she will install canopy for shades. LPA observed that a latch was installed on the gate between the facility and the Accessory Dwelling Unit (ADU). LPA advised the applicant that she needs to reside in the home to qualify for Family Child Care Home license. The applicant stated that she acknowledges this requirement.

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: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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