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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416359
Report Date: 11/28/2023
Date Signed: 11/28/2023 12:22:45 PM

Document Has Been Signed on 11/28/2023 12:22 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
SAN JOSE CC RO, 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: 6DATE:
11/28/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Yang WangTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Sheena Chin and Doni Fici and Licensing Program Manager (LPM) Gladys Kuizon visited the facility and met with the licensee, Yang Wang.

Present during visit were 2 teachers, one helper and 6 kids in care.

LPAs and LPM observed on the facility's digital room thermometer and central thermostat that the facility's room temperature today was 55 Fahrenheit. The licensee stated that the central heating was not working yesterday and the landlord said that workers will come this Thursday to fix the heating.

A Citation was issued accordingly.

Exit interview was conducted in Mandarin. This report, the appeal rights, and notice of site visit were provided to licensee today.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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Document Has Been Signed on 11/28/2023 12:22 PM - It Cannot Be Edited


Created By: Sheena Chin On 11/28/2023 at 10:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WANG, YANG
FACILITY NUMBER: 434416359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2023
Section Cited
CCR
102417(b)

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Operation of a family child care home, 102417(b). The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
The facility's central heating was not working and the temperature was 55 Fahrenheit during today's inspection..
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The licensee stated that she'll purchase portable heaters to warm the faicility and submit a picture to LPA.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Sheena Chin
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023


LIC809 (FAS) - (06/04)
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