434417419-4-16-2024-07-CC-SCHN-D4E7VN-20240416220014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417419
Report Date: 04/16/2024
Date Signed: 04/16/2024 10:00:25 PM

Document Has Been Signed on 04/16/2024 10:00 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:	SONG, YI LIN		FACILITY NUMBER:	434417419
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/16/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:50 PM
MET WITH:	Yilin Song		TIME VISIT/ INSPECTION COMPLETED:	04:15 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. On 4/16/24 Licensing Program Analyst (LPA) Sheena Chin conducted a scheduled Pre-Licensing visit. LPA met with the applicant Yilin Song. The applicant submitted an application for a small Family Child Care Home on 3/28/24. The facility will operate from 8:30am to 6:00pm, Monday through Friday, and serve children from 3 months to 5 years of age. The applicant stated that she rented this property. The adult residing in the house was the licensee. The licensee stated that her husband would move in the property from overseas in a couple of months. LPA advised the licensee to submit her husband background clearance and TB test result to the department. Observations The applicant and LPA toured inside and outside of the facility, a one-story house. Off limits are bedroom 1, bedroom 2 and kitchen. Fully charged fire extinguisher, 3A40BC, was placed in the kitchen. LPA discussed with the applicant that the fire extinguisher needs to be fully charged or replaced with a new one. The facility did not have fireplace. LPA observed that the wall units were covered by a screen. Smoke/carbon monoxide detectors were working properly in the facility. Cleaning supplies were stored in locked cabinets, inaccessible to children. There were a few toys. LPA observed that the garage was used as the day care area. The licensee stated that there’s permit for the garage to be converted to a living space according to the landlord. The landlord sent the permit via local government’s E-Onestop Online Services. The applicant stated that she will purchase more age-appropriate 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 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: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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: SONG, YI LIN	FACILITY NUMBER: 434417419
	VISIT DATE: 04/16/2024

NARRATIVE

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Required Documents
The applicant has completed Pediatric First Aid/CPR (expires on 2/11/ 25 ), Preventative Health and Safety Training( completed 2/3/24). The applicant has proofs of immunizations against pertussis, measles. The applicant stated that she’s willing to have flu shots.

The applicant stated that she was the only adult residing at this facility. The licensee stated that her husband would move in the property in a couple of months. LPA advised the licensee to submit her husband background clearance and TB test result to the department.

A review of staff records indicate 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 1/25/23. The applicant provided the lease agreement as proof of control of the property. Proof of landlord notification is required. The Property Owner/Landlord Notification form (LIC9151) was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Without this consent, the applicant understood that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children. The applicant submitted LIC 9149.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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: SONG, YI LIN	FACILITY NUMBER: 434417419
	VISIT DATE: 04/16/2024

NARRATIVE

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Page 3.

Required documents
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.

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.

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: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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: SONG, YI LIN	FACILITY NUMBER: 434417419
	VISIT DATE: 04/16/2024

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, 3/28/24, 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, Yilin Song. 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: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC809 (FAS) - (06/04)

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