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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417008
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:38:54 PM

Document Has Been Signed on 08/28/2024 03:38 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:CHENG, ANGELAFACILITY NUMBER:
434417008
ADMINISTRATOR/
DIRECTOR:		ANGELA CHENGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 701-7222
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 5DATE:
08/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:22 PM
MET WITH:Angela ChengTIME VISIT/
INSPECTION COMPLETED:
03:53 PM
NARRATIVE
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On 08/28/2024, Licensing Program Analyst(LPA) Mandeep Kaur conducted an unannounced annual/Random inspection. LPA met with Licensee Angela Cheng and explained the reason for the inspection. Present during today's inspection were Licensee, an assistant(S1), four children and Licensee's one minor child.

The hours of operation are Monday through Friday 9AM to 6PM. There is a board to post required postings,
such as license and notification of parent's rights.

LPA toured the inside and outside of the home with Licensee. The off-limits areas inside are family room, kitchen, 2 bedrooms and detached garage. Disinfectant and cleaning supplies were inaccessible to children. LPA reminded Licensee that anything sharp or states to keep out of reach of children, such as blades or razors need to be inaccessible.

LPA reviewed a copy of current children's roster during the inspection. There are toys and equipment for children inside and outside of the home. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 06/14/2024. Licensee stated that there are no weapons, such as firearm, stored in the home.


**Continue on next pages**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHENG, ANGELA
FACILITY NUMBER: 434417008
VISIT DATE: 08/28/2024
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**Continuation from 809**

LPA reviewed four (4) children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC 282), and Immunization Records.
LPA reviewed an assistant's file for the following records: Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), TB test, and required training. Licensee and her adult assistant have immunizations in measles, pertussis and flu. Licensee has current Mandated Reporter Training certificate that was completed on July 09, 2023. Licensee has current Pediatric CPR/First Aid certifications with an expiration date of October 14, 2025. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

LPA provided and discussed the safe sleep regulations with Licensee 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 reminded Licensee 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 she registers all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The adults 18 and over living in the home are Licensee and her two adult children. All adults have cleared
criminal record and child abuse index. Licensee was reminded that all adults 18 and over living or working in
the home, including employees and volunteers, except as specified in Health and Safety Code section
1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families
obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs)
throughout California.
**Continue on next page-809-C**
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 2 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHENG, ANGELA
FACILITY NUMBER: 434417008
VISIT DATE: 08/28/2024
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**Continuation from 809-C**

During the exit interview, the Licensee, Angela Cheng, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

As a result of this inspection, no deficiency is issued. Exit interview conducted and report was reviewed with Angela Cheng. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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