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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410845
Report Date: 05/10/2023
Date Signed: 05/10/2023 11:11:43 AM

Document Has Been Signed on 05/10/2023 11:11 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:SUN, XIAOHONGFACILITY NUMBER:
434410845
ADMINISTRATOR:SUN, XIAOHONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 507-2809
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Oscar Huang conducted a case management to the facility as that licensee, Xiaohong Sun contacted LPA sometime in early this year regarding relocation application procedure and LPA had not heard from her since. LPA looked up on Guardian and LIS, and observed licensee has obtained a FCCH licensee, # 075700250, located at 107 Medinah Place, San Ramon, CA 94583.

Upon arrival, LPA knocked the door (no door bell), no one answer, but two dog barking. LPA peeked through the front door, all the lights are off, there appeared no one in the home. while LPA was writing the report, a women drove a Honda Mini-van came and parked on the drive way. LPA introduced himself and asked if she knows what happened. The woman (last name, Li) stated that she does not know who lived in the house before, she moved in in January this year. She stated that she sometimes received letter from the department.

LPA therefore concluded that licensee has moved, and no longer operate the facility in this location. The closure of the the facility will be submitted for approval.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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