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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416468
Report Date: 10/29/2021
Date Signed: 12/08/2021 04:52:14 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/08/2021 04:52 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:SHIN, JULIEFACILITY NUMBER:
434416468
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Julie Shin TIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Stephanie Collins conducted an unannounced inspection. LPA met the Licensee Julie Shin and informed the licensee of the nature of the inspection; Due the Licensee submitting an application for an increase in capacity from a small to a large Family Child Care licensed home. The licensee has at least 4 years of previous experience working in a structured child care environment (License Preschool Center) experience on file. therefore, qualifies to request to operate a large family day care per regulations.

There were 6 child present during inspection and husband (Sung Eun Shin). Adults who are over the age of 18 and reside in the home are the Applicant and Applicant's Spouse
(Sung Eun Shin). Both have Clearances for Criminal Record and Child Abuse Index Background Check, and Tuberculosis. Days and hours of operation will be Monday through Friday 8:00 AM to 5:30 PM. Applicant has completed 16 hours of training on preventive health practices with lead exposure, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition. Applicant's Pediatric and CPR certification expires 10/10/22. Applicant has documented proof of immunity against Measles and Pertussis. Applicant's Certification of Completion of the AB1207 Mandated Reporter Training expires 10/20/2022.

Licensee is applying for an increase in capacity for the Family Child Care Home from 8 to 12 preschool children. MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

LPA observed that the home has a fully charged 2A:10BC fire extinguishers and a fire Pull Station has been installed near front door. Fire inspection was completed 10/28/2021 per licensee. Fully functioning carbon monoxide detectors were observed.



SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2021
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: SHIN, JULIE
FACILITY NUMBER: 434416468
VISIT DATE: 10/29/2021
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Pp2
Family Child Care Homes
Licensee Julie Shin 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.
Safe Sleep
LPA discussed the safe sleep regulations with licensee [or facility representative] 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.

Licensee is encouraged to frequent the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.
Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.

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



1: Pending : Final Approval from Fire Department.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC809 (FAS) - (06/04)
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