434417905-8-28-2024-07-CC-MSMS-D8KPNH-20240828112758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417905
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:28:31 AM

Document Has Been Signed on 08/28/2024 11:28 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:	HUO, XIA		FACILITY NUMBER:	434417905
ADMINISTRATOR/ DIRECTOR:	XIA HUO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 966-2832
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/28/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Xia Huo		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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	Licensing Program Analysts (LPAs) Mel Matos and Andy Yang met with Xia Huo, Applicant, to conduct an announced prelicensing (change of location) inspection at 1165 Prescott Ave, Sunnyvale CA 94089. Applicant is currently licensed at 950 Redwood Ave, Sunnyvale, CA 94086 (#434416341). LPAs were granted access to the home by the Applicant. Applicant and Applicant's adult friend were the only adults present in the home during today's inspection. The Applicant is the only adult residing in the home. There are no minor children residing in the home. Days and hours of operation will be Monday - Friday from 8:30 AM to 6:30 PM. Applicant completed her Preventative Health and Safety Training on 03/14/2021 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 09/16/2025. Applicant completed the Mandated Reporter Training for Child Care Workers on 07/30/2024 and a copy of the certification is on file. A copy of current TB test, Mmr, Tdap, and flu (opt out)vaccinations for the Applicant are on file. Because the Applicant rents/leases the home, proof of landlord notification is required. LPAs observed the Property Owner/Landlord Notification form (LIC 9151) that the Applicant confirms was provided to the property owner/landlord. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Copies of both documents are on file. Applicant provided proof of control of property to the Department prior to today’s inspection and a copy of the lease agreement is on file. Applicant does have liability insurance through Markel Insurance Company. LPAs observed a copy of a valid policy during today's inspection. LPAs toured the indoor and outdoor areas of the home with the Applicant during today's inspection. There are no stairs, fireplace units, or wall heater units inside the home. Off limit areas inside the home: bedrooms 1, 2, & 3, bathroom 2, kitchen, and attached garage. Off limit areas outside the home: front yard and left side area of the backyard, . The home is clean, orderly, including heating/air conditioning and ventilation, for safety & comfort. The Applicant has a valid phone in the home (#408-966-2832). There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
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: HUO, XIA	FACILITY NUMBER: 434417905
	VISIT DATE: 08/28/2024

NARRATIVE

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LPAs observed a fully charged fire extinguisher (3A40BC), working combo smoke & carbon monoxide detectors, no bodies of water, and fenced backyard. Applicant states that she does not have any pets or weapons/ammunition in the home.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that there are no poisons in the home. LPAs reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that a child will be isolated in the one of the bedrooms if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touchless thermometer in the home.

Forms of discipline to be used by Applicant: redirection. 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. LPAs informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Applicant states that she will not administer any medication to the children at this time. 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.

Xia Huo, 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.

LPA reviewed with Xia Huo, 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. Prelicensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

A fire safety inspection approval was received from the Sunnyvale Department of Public Safety on July 29, 2024.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
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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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: HUO, XIA	FACILITY NUMBER: 434417905
	VISIT DATE: 08/28/2024

NARRATIVE

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LPA discussed the safe sleep regulations with Xia Huo, 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, licensee, or facility representative] 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.

On this date, 07/18/2024, 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 addresses. 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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

Applicant states that she is still residing at her old residence and will permanently move to this residence as of August 31, 2024. She plans to start day care at this residence as of Tuesday September 3, 2024.

Today's report was translated from English to Mandarin by LPA Yang.

Exit interview conducted and report was reviewed with the Applicant, Xia Huo. LPAs advised the Applicant that a large Family Child Care Home license will be approved effective Tuesday September 3, 2024.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
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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