<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700384
Report Date: 10/17/2023
Date Signed: 10/17/2023 06:38:08 PM

Document Has Been Signed on 10/17/2023 06:38 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:SHIN, JULIEFACILITY NUMBER:
435700384
ADMINISTRATOR:SHIN, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 963-8103
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
10/17/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Julie ShinTIME COMPLETED:
05:30 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 Tuesday, October 17, 2023, at 4 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Pre-Licensing Visit. LPA met with the Applicant Julie Shin. Present on this visit were the Applicant's Spouse and Applicant's infant child of her own. The applicant submitted a Family Child Care Home (FCCH) Relocation Application (previous License number 434416468) and Oakland South Child Care Program Office received the application on 6/16/23. The Fire Inspection Request and approved by Milpitas Fire Department on 9/14/23.

The home was toured to conduct a Health and Safety Inspection with the Applicant. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort. The home plans to operate from Monday to Friday 8:30 am to 5 pm.

The On-Limit Areas are the Guest Room, Dining Room, Family Room, 1 Bathroom adjacent to the Guest room, 1 hallway bathroom adjacent to the Kitchen and Backyard. The backyard 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 tubes, or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible. The designated isolation area is the Guest Room when a child gets sick in day care.

The Off-Limit Areas are Bedroom number 3 and 4 on the first floor, the kitchen, the entire second floor and the garage. LPA observed safety gates installed on the bottom and top of the stairs, locked cabinets and or with safety latches installed, locked doors on off limit areas and child proof outlet covers.

The home has a fully charged fire extinguisher 3A40BC, smoke detector, carbon monoxide, telephone (cell phone). As per the Licensee, there are no firearms on the premises. The home does have a fireplace and LPA reminded the applicant must be made inaccessible to children in care by safety gates or barricade. The Applicant understood.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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: SHIN, JULIE
FACILITY NUMBER: 435700384
VISIT DATE: 10/17/2023
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
The applicant completed the Health and Safety training completed on 10/11/2020, and CPR (Pediatric) and First Aid completed on 09/10/2023 with validity period of 2 years. The applicant completed the AB1207 Child Care Providers training online on 8/17/23. LPA reminded the applicant that AB1207 requires a 2-year renewal. The applicant has records of Measles and Pertussis immunization, Influenza declination statement and TB clearance. LPA reminded the applicant that only the Influenza vaccination can be decline with a written declination. LPA reviewed the applicant's Residential Lease Agreement signed as of 06/16/2023, LIC 9149 PROPERTY OWNER/LANDLORD CONSENT FAMILY CHILD CARE HOME and LIC 9151 PROPERTY OWNER/LANDLORD NOTIFICATION FAMILY CHILD CARE HOME.

LPA provided technical assistance during inspection with the following.


1. Review of all required forms and information to be kept on file (Children’s forms/Records, Facility forms/Records, Information to be posted) 2. Reporting and Notifications Requirements 3. General Information (Child Care Updates, Provider Information Notification, etc.) 4. Miscellaneous Resources - Resources for Providers https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers and Watch these brief, informative videos to learn more about putting Licensing regulations and requirements into practice - https://ccld.childcarevideos.org/family-child-care-providers/

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

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-and-resources/safe-sleep as an additional resource. LPA also informed the 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.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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: SHIN, JULIE
FACILITY NUMBER: 435700384
VISIT DATE: 10/17/2023
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
LPA provided the The SCC R&R Program Santa Clara County Office of Education contact information - (669) 212 - 5437, 1290 Ridder Park Dr. MC 261 San Jose, CA 95131https://www.childcarescc.org/providers/about-childcare-portal

​​​​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.


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 platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The home is recommended for a FCCH Large license effective today, 10/17/2023.

Exit interview conducted and report was reviewed with the applicant, Julie Shin.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3