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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416359
Report Date: 01/20/2022
Date Signed: 01/20/2022 03:05:59 PM

Document Has Been Signed on 01/20/2022 03:05 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:WANG, YANGFACILITY NUMBER:
434416359
ADMINISTRATOR:WANG, YANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 252-0397
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/20/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Yang WangTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Oscar Huang met with Yang Wang for an announced inspection in response to licensee relocation & increase requests. Licensee currently has a small FCCH license (#434416228) located at 6512 Fall River Dr. San Jose, CA 95120. LPA explained the nature of today’s inspection to Licensee. LPA observed no children at home. Days and hours of operation are Monday to Friday, 8:30am to 6:00pm. The adults that reside in the home are Licensee & A helper/tenant. Licensee has completed her 8 hours of Preventative Health and Safety Child Care Training which includes 2016 Nutrition on 09/15/2019, and a copy of the certification card is on file. Applicant's CPR and First Aid certifications are current and will be expired on 01/2024. Applicant rents the home and a copy of lease agreement & Landlord notification are also on file. LPA advised licensee that her son who is under 10 years old will be accounted for her capacity when present during operation hours.

Licensee, Yang Wang 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. A review of staff records on today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Licensee observed the temperature was 69 degree displayed on the thermometer, LPA advised her to keep temperature within 68-85 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. LPA observed no stairs inside the home. The main area of the home is used for the day care are Living Room room, and Bathroom #1. LPA observed a blocked fireplace. Off limit areas inside the home: all Bedrooms 1, 2 & 3, bathroom 2, Kitchen, and Garage. LPA observed fenced backyard, and no bodies of water. Off limits outdoor is gated left side. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored in top cabinets in the kitchen inaccessible to children.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: WANG, YANG
FACILITY NUMBER: 434416359
VISIT DATE: 01/20/2022
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LPA observed a fully charged 2A10BC fire extinguisher, at least one working smoke detector and one carbon monoxide detector. Licensee states there are no weapons/firearms and pets in the home. LPA reviewed COVID-19 infection prevention guidance & self-assessment with licensee including her plans in place to protect and support staff, children, cleaning & hygiene implementation, health screening & social distancing practices, meal times and arrival & pickup procedures. LPA advised that all adults and children above 2 years old are required to wear masks.
LPA discussed the safe sleep regulations with licensee, Yang Wang 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 [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. LPA advised her that infant under 12 months will required to fill Individual Infant Sleeping Plan (LIC 9227) and maintain 15 minutes sleep check logs for all infants under 2 years old.
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: https://www.ada.gov/childqanda.htm

A fire clearance granted from the Sunnyvale Fire Department was received on 01/19/2021 and was on file: Fire Clearance granted for new large family day care at this address. No day care use permitted in bedrooms, kitchen or garage. Mx capacity:14.

Exit interview conducted and report was reviewed with licensee Yang Wang, and advised her that a Large Family Child Care Home license is now pending upon submitting the following items to the department and management approval:

1. 2020 Lead Poisoning Prevention certificate for Preventative Health and Safety Child Care Training.


2. Helper/Tenant's TB record within 12 month & Tdap immunization record.
3. Helper/Tenant's Notice Employee Right (LIC 9052)
4. Helper/Tenant's Statement Acknowledge Requirement to Report Child Abuse (LIC 9108).
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
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