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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700360
Report Date: 05/23/2022
Date Signed: 05/23/2022 12:29:48 PM

Document Has Been Signed on 05/23/2022 12:29 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:LAI, CAI XIAFACILITY NUMBER:
435700360
ADMINISTRATOR:LAI, CAI XIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 695-9982
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cai Xia LaiTIME COMPLETED:
12:45 PM
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On Monday, May 23, 2022 at 10 am, Licensing Program Analyst (LPA) Manel Estoesta conducted unannounced Prelicensing Visit. LPA met with the Applicant Cai Xia Lai and Applicant's daughter Sandy Lai as the applicant's interpreter. The Applicant speaks Mandarin. The applicant submitted a Location Change and Capacity Change Application. The applicant previous License # 434416129. Milpitas Fire Department - Fire Clearance Granted on 5/11/2022. Present on this visit were 2 infants and 2 preschools. The home plans to operate from Monday to Friday 8:30 AM to 6 PM.

The home was toured to conduct a Health and Safety Inspection with the Licensee and Licensee's daughter. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort. The home does have a fireplace that is screened to prevent access to children.

The Off-Limit Areas are the entire second floor, the kitchen and the garage. LPA reminded the Applicant that the Off-Limit Areas will be inaccessible to children by locked doors, safety gates and visual supervision.

The on-Limit Areas are the Play Area (Napping Area), Play Area (Living Room), Lunch Area, Bathroom on the first level next to the Lunch Area and the Backyard. The designated isolation area will be Play Area (Living Room). The backyard will be a designated outdoor play area that is fully fenced. The outdoor 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 home has a fully charged fire extinguisher 2A10BC, working smoke detector, carbon monoxide, telephone (cell phone). Per applicant, there are no firearms on the premises.

The applicant completed the Health and Safety training on 1/19/19 and took the training with Lead Poisoning Prevention Course on 05/21/2022. The applicant's CPR (Pediatric) and First Aid is certified, current and expires on 3/5/2024. The Applicant will take the Mandated Reporter Training when the training is available on her Language. SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAI, CAI XIA
FACILITY NUMBER: 435700360
VISIT DATE: 05/23/2022
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Continuation.....

The Applicant does not own the premises and LPA discussed requires maintaining signed the forms LIC 282 AFFIDAVIT REGARDING LIABILITY INSURANCE. The Applicant submitted completed the LIC 9149 PROPERTY OWNER/LANDLORD CONSENT FAMILY CHILD CARE HOME and LIC 9151 PROPERTY OWNER/LANDLORD NOTIFICATION FAMILY CHILD CARE HOME in the facility file.

A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.

At 10:30 am, LPA observed 2 baby jumpers on the Play Area (Living Room) and (Napping Area). LPA discussed the regulation to the applicant. The applicant will remove the baby jumpers on the On-Limit Areas.
At 10:30 am, LPA observed 2 baby jumpers on the Play Area (Living Room) and (Napping Area). LPA discussed the regulation to the applicant. The applicant will remove the baby jumpers on the On-Limit Areas.

At 10:45 am, LPA observed no gates on stairs to prevent children to access the Off-Limit Areas. The applicant will install safety gates.

At 11 am, LPA observed safety hazards at the back of one Storage at the backyard. The applicant will install safety gates.
At 11:15 am, LPA observed on blankets in the 2 cribs, no infants were sleeping at the time. The applicant will remove the blankets.

At 11:30 am, LPA observed Locked 4 Bedroom Doors on the second story. The applicant stated that the keys are with the Landlord.

The Home is not recommended for a Large Family Child Care License due to the above missed requirements. LPA will conduct another unannounced Prelicensing Visit. The applicant understood.

The applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: LAI, CAI XIA
FACILITY NUMBER: 435700360
VISIT DATE: 05/23/2022
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Continuation......

LPA discussed the safe sleep regulations with the applicant 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 [applicant, 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.

Exit interview conducted and report was reviewed with the Applicant Cai Xia Lai and the Applicant's Daughter Sandy.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
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