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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417366
Report Date: 09/29/2023
Date Signed: 09/29/2023 03:14:23 PM

Document Has Been Signed on 09/29/2023 03:14 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:CHENG,HSIAO-YING&NAZARENO,REGINALD&HUANG,TIEN-HSINFACILITY NUMBER:
434417366
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
09/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Hsiao-Ying Cheng, Reginald Nazareno, Huang, Tien-HsinTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mel Matos met with Hsiao-Ying Cheng, Reginald Nazareno, Tien-Hsin Huang, Licensees, for an unannounced case management inspection. LPA also observed four day care children (2 infants & 2 preschool) in the home during today's inspection.

LPA reviewed four children's files during today's inspection. LPA reminded Licensees that immunization records need to be updated at least once per year depending on the age of the child. LPA also reminded the Licensees that the Child Care Facility Roster must be up to date at all times.

LPA provided a copy of the Entrance Checklist - Family Child Care Homes (LIC 126) to the Licensees prior to the conclusion of today's inspection.

Exit interview conducted and report was reviewed with the Licensees, Hsiao-Ying Cheng, Reginald Nazareno, and Tien-Hsin Huang. No deficiencies issued.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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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