435700335-5-12-2023-52-CC-MESA-CRRU3S-20230512151359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700335
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:14:08 PM

Document Has Been Signed on 05/12/2023 03:14 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZHENG, XINGXIN		FACILITY NUMBER:	435700335
ADMINISTRATOR:	ZHENG, XINGXIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 838-3097
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 10	DATE:	05/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Xingxin "Alicia" Zheng		TIME COMPLETED:	03:45 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

On Friday, May 12, 2023 at 1:45 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required One (1) Year Required visit. LPA met with the Licensee Xingxin "Alicia" Zheng and explained the nature of the site visit. Present on this visit were 2 Licensee's Assistant Yanni and Chunmei, four (6) preschool children and one (4) infant children. The home hours of operation is from Monday to Friday 8:30 AM to 5:30 PM.

LPA toured the facility to conduct a health and safety inspection. The home is a two-story home. The home is neat and clean with central heating and ventilation for safety and comfort. The home does not have a fireplace.
The OFF-LIMIT AREAS are the entire second 2nd floor, kitchen, garage, backyard and laundry room will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are living room (children activities), second living room (napping area), dining room, hallway bathroom in the first floor and the front yard.

The designated isolation area will be living room. The front will be a designated outdoor play area that is fully fenced. The outdoor area has age appropriate toys that appear to be clean and free from defects and dangerous conditions. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a charged 2A10BC fire extinguisher, working combination of smoke detector and carbon monoxide, working cell phone and fully stocked first aid kit. Per applicant, there are no firearms on the premises.

The licensee conducts and documents fire and disaster drills. Licensee owns the house and the facility does not carry childcare liability insurance or a bond and maintain the signed form LIC 282 AFFIDAVIT REGARDING LIABILITY INSURANCE.

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHENG, XINGXIN	FACILITY NUMBER: 435700335
	VISIT DATE: 05/12/2023

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
26
27
28
29
30
31
32

Continuation.

Licensee and Licensee's Assistants have current records of Measles and Pertussis immunization, Influenza vaccination and TB clearance, CPR and First Aid certificate and Mandated Reporter Training Certificates. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Sleep Logs and Immunization.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHENG, XINGXIN	FACILITY NUMBER: 435700335
	VISIT DATE: 05/12/2023

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
26
27
28
29
30
31
32

Continuation.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA discussed to the Licensee. the American Rescue Plan Act Survey and grants for new construction and major renovation of child care programs.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There are no deficiencies cited on this visit.

Exit interview conducted and report was reviewed with the licensee, Xingxin "Alicia" Zheng.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3