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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417398
Report Date: 08/28/2024
Date Signed: 08/28/2024 10:55:43 AM

Document Has Been Signed on 08/28/2024 10:55 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:GU, TINGFACILITY NUMBER:
434417398
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
08/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ting Gu TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced Case Management inspection to the home today. LPA explained licensee Ting Gu and to her husband Xie Xiang Sheng, the visit is to inspect her Family Child Care Home for the increase of capacity. Licensee has submitted an application for increase of capacity and her home has been granted a clearance by the Sunnyuvale Department of Public Safety on 8/13/24. Licensee Ting Gu, her spouse Xie Xian Sheng and her cousin Shuanglei Wang are the only adults residing in the one story home. LPA observed six children were in care during the inspection. Days and hours of operation are Monday to Friday from 8:30 AM to 7:00 PM. Licensee's pediatric CPR and First Aid certifications are current and will expire on 8/19/25
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed there are not wall heaters or bodies of water in the home. LPA observed there are no stairs inside the home. Off limit areas inside the home: Three bedrooms, one bathroom, the kitchen, and the attached garage. LPA observed licensee has a 3A40BC fire extinguisher in the home. The home has at least one working smoke detector, and at least one working carbon monoxide detector. Off limits outdoor areas are: Right and left side yards. LPA observed the licensee has her laundry area located in the off limits garage. LPA observed there are no pet animals in the home. Licensee's husband states that there are no weapons in the home. LPA observed that licensee is using the back yard as playground for the children in care and it is fenced. LPA observed the home has a fireplace which is barricaded with children's cubbies. Licensee understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. Licensee has completed the required "mandated reporter" training AB1207 on 8/24/23.

Licensee was informed that if eventually a large license is granted, the maximum capacity is 14 and a qualified helper is required to be present whenever there are more than 8 children in care and ratio (age of the children) must be observed. Licensee understands that in absence of a qualified helper, her license capacity automatically returns to capacity 8 and ratio must be observed as well. Graphical material showing ratio for a large FCCH license was provided to the licensee.

*********Report dated 8/28/24 continues on page 2
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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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: GU, TING
FACILITY NUMBER: 434417398
VISIT DATE: 08/28/2024
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Report dated 8/28/24 continues from page 1.

A review of staff records on 8/27/24 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee was reminded that all the adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee Ting Gu and with her spouse Xie Xian Sheng.

Licensee was informed that a large Family Child Care Home license would be approved pending on the following: 1) Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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