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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416545
Report Date: 02/22/2023
Date Signed: 02/22/2023 11:03:48 AM

Document Has Been Signed on 02/22/2023 11:03 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:WANG, WENJINGFACILITY NUMBER:
434416545
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
02/22/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Wenjing WangTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Cynthia Tamayo and Mel Matos met with Applicant, Wenjing Wang, to conduct an announced prelicensing inspection at 2114 Stratton Place San Jose CA 95131. LPAs were granted access to the home by the Applicant. Applicant's Spouse (Yulei Wang), and Applicant's two minor daughters (ages 3 & 2 years) were present during today's inspection. The Applicant and her spouse are the only adults residing in the home. Applicant has two minor daughters (ages 3 & 2 years) residing in the home.

Days and hours of operation will be Monday - Friday from 8:30 AM- 6:00 PM. The Applicant completed her Preventative Health and Safety Child Care Training on 1/28/2023 and a copy of the certification is on file. The Applicant's CPR and First Aid certifications are current and expire on 12/2024. The Applicant has completed the Mandated Reporter Training for Child Care Workers on 12/20/2022 and a copy of the certification is on file. A copy of current TB test, flu, MMR (medically exempt due to being pregnant), and Tdap vaccinations for the Applicant is on file. Applicant owns the home and a copy of property tax payment verifying control of property is on file. Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) until she obtains insurance coverage.

LPAs toured the indoor and outdoor areas of the home with the Applicant during today's inspection. There are not any stairs or wall heater units inside the home. There is a 40 gallon aquarium (with at least one dozen goldfish inside), located in the kitchen area of the home, that is safe and secure. LPAs reminded the Applicant that all pet food and cleaning products must be kept inaccessible to the day care children. Off limit areas inside the home: barricaded fireplace in the living room area, bedrooms 1 & 2, bathroom 1, and attached garage. Off limit area outside the home: entire backyard. Applicant states that the children will utilize the fenced front yard area for outdoor play and activities. Applicant understands that children must be supervised at all times while outdoors in the front yard area.

The home is clean, orderly, (including heating/air conditioning), and ventilation for safety & comfort. Applicant has a valid phone in the home (408-669-9467). There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors. LPAs observed a fully charged fire extinguisher (2A10BC) and working smoke and carbon monoxide detectors, and fenced front yard. Applicant states that he does not have any weapons/ammunition or pets in the home.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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: WANG, WENJING
FACILITY NUMBER: 434416545
VISIT DATE: 02/22/2023
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Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that there are no poisons in the home. LPAs reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will only provide snacks for the day care children. Applicant states that parents will be responsible for providing lunches & milk for the day care children. LPAs reminded the Applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s). Applicant states that she will not administer any medication to the children at this time. Applicant state that a child will be isolated in the kitchen area if necessary due to illness or communicable disease. Applicant has a First Aid kit with a touch less thermometer in the home.

Forms of discipline used by Applicant: positive discipline and talking to children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPAs informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Weijing Wang, 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.

LPAs discussed the requirements of AB 633 with the Applicant. Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPAs discussed "zero tolerance" related regulations with the Applicant and advised them of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPAs provided and reviewed the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPAs provided and 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. LPAs also informed the Applicant 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
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: WANG, WENJING
FACILITY NUMBER: 434416545
VISIT DATE: 02/22/2023
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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: http://www.ada.gov/childqanda.htm

PIN 22-02-CCP - Best Practices Related to the Provision of Incidental Medical Services in Child Care Center and Family Care Homes was provided to the Applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Weijing Wang, and LPAs advised her that a small Family Child Care Home License will be approved upon completion of the following:

1. Photo of locks installed under kitchen sink cabinet and bathroom vanity OR relocation of cleaners from accessible cabinets.
2, Approval of Application by LPA's Manager.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC809 (FAS) - (06/04)
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