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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417366
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:43:42 AM

Document Has Been Signed on 12/11/2024 11:43 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHENG,HSIAO-YING&NAZARENO,REGINALD&HUANG,TIEN-HSINFACILITY NUMBER:
434417366
ADMINISTRATOR/
DIRECTOR:		CHENG,NAZARENO,HUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 777-8531
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
12/11/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Hsiao-Ying Cheng & Reginald ZazarenoTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) met with Hsiao-Ying Cheng & Reginald Nazareno, Licensees, for an unannounced case management inspection. LPA also observed nine day care children, Tien_Hsin Huang, co-Licensee, and one adult resident during today's inspection.

LPA advised the Licensees of the required paperwork and fee that will need to be submitted if they decide to purchase and move to another residence in the future:

1) Application for a Family Child Care License (LIC 279)
2) Current Children in Your Home - Application for a Family Child Care Home License (LIC 279B)
3) Facility Sketches - indoor/outdoor - (LIC 999A)
4) Emergency Disaster Plan (LIC 610A)
5) Pre-Licensing Readiness Guide FCCH (LIC 9217)
6) Proof of control of property
7) Change of location fee: $70 payable to DSS - Cashier

Exit interview conducted and report was reviewed with the Licensees, Hsiao-Ying Cheng & Reginald Nazareno. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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