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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417366
Report Date: 03/27/2024
Date Signed: 03/27/2024 09:42:38 AM

Document Has Been Signed on 03/27/2024 09:42 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: 6CENSUS: 6DATE:
03/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Hsiao Ying Cheng, Reginald Nazareno, & Tien-Hsin HuangTIME COMPLETED:
10:00 AM
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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.

Purpose of today's inspection: Facility has submitted an updated Indoor Facility Sketch (LIC 999A) requesting to make Bedroom #1 accessible to children and Bedroom #3 inaccessible to children. Bedroom #2 remains unchanged (inaccessible to the children).
LPA toured the home and observed that Bedroom #1 is in process of getting set up for day care use. Reginald states he anticipates that Bedroom #1 will be set up by this weekend. Reginald agreed to submit pictures of Bedroom #1 when it is set up. Reginald understands that he cannot start using Bedroom #1 until it is completely set up for day care use.

Exit interview conducted and report was reviewed with the Licensee, Reginald Nazareno. 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: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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