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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417881
Report Date: 08/20/2024
Date Signed: 08/21/2024 08:50:58 AM

Document Has Been Signed on 08/21/2024 08:50 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LI, CAIYUNFACILITY NUMBER:
434417881
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/20/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Caiyun LiTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On 08/20/2024 at 9:24am, Licensing Program Analyst (LPA), Farida Raja met with Applicant, Caiyun Li to conduct an announced pre-licensing inspection. LPA was granted access to the home by the Applicant and explained the purpose of today's visit. Per Applicant, the adults that reside in the home are applicant, mother, boyfriend and daughter and all have valid fingerprint and tuberculosis clearances. Applicant has three minor children residing in the home. Present during the inspection were applicant and adult daughter.

Days and hours of operation will be Monday - Friday from 8:30 AM to 6:00 PM and will serve children ages 1.5-5 years old. Applicant submitted an updated Application for a Family Child Care Home License (LIC 279) during today's inspection. Applicant completed her Preventative Health and Safety Child Care Training on 03/20/2022 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 04/20/2026. Applicant has completed the Mandated Reporter Training for Child Care Workers on 08/19/2024. A copy of current TB test (applicant and all adults residing in the home), MMR, Tdap and influenza vaccinations for the Applicant are on file. LPA advised applicant that applicant's children under 10 years of age will be counted in the capacity if present during facility operating hours.

Applicant rents the home and provided a copy of the current lease agreement as proof of control of property. LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant states that she is planning to obtain daycare insurance once licensed.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LI, CAIYUN
FACILITY NUMBER: 434417881
VISIT DATE: 08/20/2024
NARRATIVE
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The property has an Accessory Dwelling Unit (ADU) at 706 S Mary Avenue, which has an independent access. Daycare operations will be conducted in the ADU. Applicant provided building permit for the ADU to LPA during today's inspection. The ADU has one room, one bathroom and kitchen which will be on limits to children. LPA observed two gates on the left side of the home that applicant states will be used by daycare parents for drop off and pick up. The gates lead to a separate entrance for the ADU. LPA toured the indoor and outdoor areas of the home and ADU with applicant during today's inspection. The home is single story with 4 bedrooms and 3 bathrooms and the Accessory ADU is not connected to the main home. Applicant stated that the entire main house and garage will be off limits to children in care. The home is the front home of the property. The ADU is in the back of the home and is registered with the post office with a separate address. There are no stairs or fireplace in the ADU.

LPA inspected home for any health and safety hazards. There are sufficient age appropriate toys and equipment for the day care children. The floor is free of tripping hazards with toys placed in shelves. Areas accessible to children were inspected to ensure that they are clean and orderly. Cleaning products, toxic agents, medications, and sharp objects were inaccessible to children. The home has heating, air conditioning and ventilation for comfort of children. LPA observed knives and sharps placed out of reach of children. Bathroom used by children was in operating condition. Toilets and faucet are clean and operable. Shower area was observed to be used as storage to store nap cots. Applicant currently has six cots available for napping. LPA observed cleaning tablets under the sink and advised applicant to either child lock cabinet or place items out of reach of children.

Backyard is fenced and gated on both sides. Applicant understands that children must be supervised at all times while outdoors. LPA observed age appropriate toys and play structure in safe condition outdoors. The backyard has a deck area and artificial grass area. There are no bodies of water observed. Shade is provided outdoors by canopies. Off limit areas outdoor: storage shed and locked cabinet. LPA observed a gap between the fence and storage shed on the back and left side that is big enough to fit a child. LPA advised applicant to make the area inaccessible to children. Applicant stated that fenced front yard may also be used for daycare children. LPA inspected the area and observed it to be fenced and safe for children to use.

Applicant has one weapon in the home which is stored in the main house. LPA observed ammunition stored along with the weapon. LPA informed applicant that ammunition needs to be stored away from the weapon and inaccessible to children. Applicant removed the ammunition and placed it in a different area of the home.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LI, CAIYUN
FACILITY NUMBER: 434417881
VISIT DATE: 08/20/2024
NARRATIVE
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Licensee has a working telephone in the home (408-858-2817). LPA observed a fully charged fire extinguisher (3A40BC) and a working smoke and carbon monoxide detector. LPA reminded applicant that the fire extinguisher needs to be serviced once every 12 months. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant has one dog. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will provide lunch and snacks for the day care children. LPA reminded applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s). Drinking water will be provided to children via individual water bottles and refilled using filtered water. LPA advised applicant to have postings near the entrance so it is visible to parents/authorized representatives.

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, 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.

Form of discipline will be to distract children and have them focus on something else. Licensee states that she will not use time outs. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. Applicant will isolate a sick child in a separate area of the ADU room in case of illness or communicable disease.

LPA discussed the requirements of Assembly Bill(AB) 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.



Continued on Page 4
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LI, CAIYUN
FACILITY NUMBER: 434417881
VISIT DATE: 08/20/2024
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LPA discussed the safe sleep regulations with 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.

LPA reviewed with applicant the LIC 311D, 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. Applicant states that she may provide transportation if needed and LPA reminded applicant that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

Incidental Medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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.

On this date, 08/19/2024, 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 address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been 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.



Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare 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: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LI, CAIYUN
FACILITY NUMBER: 434417881
VISIT DATE: 08/20/2024
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Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.

LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time and ratio (age of the children) must be observed.

Exit interview conducted and report was reviewed with the Applicant, Caiyun Li. LPA advised Applicant that a small Family Child Care Home License will be approved upon completion of the following and supervisor approval.


  1. Submission of facility sketch for the main house including room sizes and all on and off limit areas.
  2. Picture proof of child lock on bathroom cabinet.
  3. Picture proof of area behind and on the side of the storage shed made inaccessible to children.
  4. Picture proof of locked storage shed.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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