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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417366
Report Date: 09/06/2023
Date Signed: 09/06/2023 11:36:02 AM

Document Has Been Signed on 09/06/2023 11:36 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHENG,HSIAO-YING&NAZARENO,REGINALD&HUANG,TIEN-HSINFACILITY NUMBER:
434417366
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
09/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Hsiao-Ying Cheng, Reginald Nazareno, Huang, Tien-HsinTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Hsiao-Ying Cheng, Reginald Nazareno, Tien-Hsin Huang, Applicants, to conduct an announced prelicensing inspection at 354 E. Arbor Avenue, Sunnyvale CA 94085. LPA was granted access to the home by the Applicants. Applicants were the only adults present in the home during today's inspection. Applicants and Li-Hung Huang, Hsiao-Ying & Reginald's adult son, are the adults residing in the home. There is one minor child, age 8 years old, residing in the home.

Days and hours of operation will be Monday - Friday from 7:30 AM to 6:00 PM. Applicants completed their Preventative Health and Safety Training on 08/06/2023 and copies of the certifications are on file. Applicants CPR and First Aid certifications are current and expire 07/15/2025. Applicants Mandated Reporter Training for Child Care Workers are current and copies of the certifications are on file. Copies of current TB test, Mmr, Tdap, and flu (opt out) vaccinations for the Applicants are on file. Because the Applicant rents/leases the home, proof of landlord notification is required. Applicants provided proof of control of property to the Department prior to today’s inspection and a copy of the lease agreement is on file. The Property Owner/Landlord Notification form (LIC 9151) that the Applicants confirm was provided to the property owner/landlord is on file. Applicants obtained a signed Property Owner/Landlord Consent form (LIC 9149) and a copy is file. Applicants do not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolling families unless they obtain liability insurance in the future.

LPA toured the indoor and outdoor areas of the home with the Applicants during today's inspection. There are no stairs and wall heater units inside the home. Off limit areas inside the home: two bedrooms, one bathroom, two barricaded fireplace units (located in the living room & family room), and attached garage. Off limit areas outside the home: right side area of the home and locked storage shed.

The home is clean, orderly, including heating and ventilation, for safety & comfort. The Applicants have a valid phone in the home (#669-777-8531). There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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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: CHENG,HSIAO-YING&NAZARENO,REGINALD&HUANG,TIEN-HSIN
FACILITY NUMBER: 434417366
VISIT DATE: 09/06/2023
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LPA observed a fully charged fire extinguisher (3A40BC), working smoke & carbon monoxide detectors, no bodies of water, and fenced front and backyard. Applicants state that they do not have any weapons/ammunition in the home. Applicants have a corn snake that is kept in an enclosure in an off limits bedroom of the home. Applicants state that they will provide snacks and lunch to the day care children. Applicants understand that any food brought from home shall be labeled with each child's name and properly stored.

Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicants state that any poisons are stored in the locked shed in the backyard. LPA reminded Applicants that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that they will not administer any medication to the children at this time. Applicants state that a child will be isolated in the on limits bedroom if necessary due to illness or communicable disease. Applicants have a First Aid kit with a touchless thermometer in the home.

Forms of discipline to be used by Applicant: talking to children and time-out. Applicants understand 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. LPA informed the Applicants that fire/disaster drills must be practiced at least once every 6 months and documented.

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) or (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.

Applicants were 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, 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.

LPA reviewed with Applicants, 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. Prelicensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicants.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CHENG,HSIAO-YING&NAZARENO,REGINALD&HUANG,TIEN-HSIN
FACILITY NUMBER: 434417366
VISIT DATE: 09/06/2023
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LPA discussed the safe sleep regulations with Applicants and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Applicants 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.

On this date, 07/26/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicants were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Exit interview conducted and report was reviewed with the Applicants, Hsiao-Ying Cheng, Reginald Nazareno, Huang, Tien-Hsin. LPA advised the Applicants that a small Family Child Care Home license is approved effective today, September 6, 2023.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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