435700384-9-24-2024-52-CC-MESA-D9ERU6-20240924131926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700384
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:19:34 PM

Document Has Been Signed on 09/24/2024 01:19 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, JULIE		FACILITY NUMBER:	435700384
ADMINISTRATOR/ DIRECTOR:	SHIN, JULIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 963-8103
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	09/24/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:00 AM
MET WITH:	Licensee Julie Shin		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

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On 9/24/2024 at 11 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Annual / Random Inspection. LPA met with the Licensee Julie Shin. Present on this visit were the Licensee’s Assistant Provider MIRYUNG SO, 5 preschool children, licensee's preschool child of her own and one infant child. The home operates from Monday to Friday 8:30 am to 5 pm.

The home was toured to conduct a Health and Safety Inspection with the Licensee. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort.

The On-Limit Areas are the Guest Room, Dining Room, Family Room (used for nap time), 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 play 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. LPA observed some furniture was blocking the home’s fireplace to prevent children’s access to it. LPA observed children’s safety gates on the bottom of the stairs and in the kitchen.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHIN, JULIE	FACILITY NUMBER: 435700384
	VISIT DATE: 09/24/2024

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Because the licensee rents/leases the home, proof of landlord notification is required. The LPA reviewed the completed Property Owner/Landlord Notification form (LIC9151) and a signed Property Owner/Landlord Consent form (LIC 9149) by the licensee.

The licensee CPR and First Aid certificate and expired on 9/10/2024. The licensee completed the Mandated Reporter Child Care Providers training online at https://mandatedreporterca.com/ on 8/17/23. The licensee has records of Measles and Pertussis immunization. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information and Consent for Emergency Medical Treatment form. The licensee is in ratio today. Licensee stated that she does not transport children at this time.

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 [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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHIN, JULIE	FACILITY NUMBER: 435700384
	VISIT DATE: 09/24/2024

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

There were no deficiency/ies cited on this visit.

LPA educated the licensee to contact Santa Clara County's Childcare Resource and Referral team at web: https://www.childcarescc.org, email: childcarescc@sccoe.org and or phone: 669-212-5437. The R&R Program may reimburse each eligible childcare provider a portion of the cost of up to $150 annually for completing approved health and safety training/courses. Approved Preventative Health and Safety and/or Pediatric CPR/First Aid training/course must be offered by the American Heart Association, American Red Cross, or an EMSA–approved Preventative Health and Safety training agency. Training/course must be completed between July 1, 2024 – April 11, 2025.

Licensee was informed of the MyChildCarePlan.org website; 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.

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

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

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC809 (FAS) - (06/04)

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