434417439-10-23-2024-07-CC-FRAA-DABPQY-20241023113157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417439
Report Date: 10/22/2024
Date Signed: 10/23/2024 11:41:10 AM

Document Has Been Signed on 10/23/2024 11:41 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	TAN, XUEBING		FACILITY NUMBER:	434417439
ADMINISTRATOR/ DIRECTOR:	XUEBING TAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 813-8800
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/22/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:39 AM
MET WITH:	Xuebing Tan		TIME VISIT/ INSPECTION COMPLETED:	11:20 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/22/2024 at 8:39am, Licensing Program Analyst (LPA), Farida Raja met with Applicant, Xuebing Tan, to conduct an announced pre-licensing inspection. LPA was granted access to the home by the Applicant and explained the purpose of today's visit. Per applicant, she is the only adult that resides in the home. Owner of the home, Li-Fan Mock arrived during the inspection and was present for the duration of the visit. LPA interviewed Applicant and Owner and confirmed the mailing address listed on the Application (LIC 279). Licensee states that she has no minor child residing in the home. The home is single story with 2 bedrooms and 2 bathrooms. Days and hours of operation will be Monday - Friday from 7:30 AM- 6:30 PM. Applicant completed her Preventative Health and Safety Child Care Training on 06/02/2024 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 06/22/2026. Applicant has completed the Mandated Reporter Training for Child Care Workers on 09/11/2024. A copy of current TB test, MMR, Tdap and statement declining influenza for the applicant are on file. Applicant rents the home and provided a copy of the current lease agreement as proof of control of property. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. Applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). LPA toured the indoor and outdoor areas of the home during today's inspection. Off limit areas inside the home: barricaded kitchen, pantry, one bedroom and one bathroom. LPA inspected home for any health and safety hazards. Areas accessible to children were inspected to ensure that they are clean and orderly. There are no fireplaces or wall heaters in the home. LPA observed sufficient toys, supplies, and equipment for the day care children. LPA observed child sized furniture including tables, chairs, shelves, cubbies and diaper changing table which is in good condition, free of sharp, loose or pointed parts.The home has central heating, cooling and ventilation for comfort of children. LPA observed the bathroom used by children was in operating condition. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TAN, XUEBING	FACILITY NUMBER: 434417439
	VISIT DATE: 10/22/2024

NARRATIVE

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Toilets and faucet are clean and operable. LPA observed that children will only use the gated deck/play area outdoors. Off limit areas outside the home include gated area on the deck, right and left side sections, five locked storage sheds, remaining yard and detached garage. Backyard is fenced and both sides of the home are gated. Applicant understands that children must be supervised at all times while outdoors. Outdoor area is carpeted and LPA observed shade provided by building overhang and canopy. LPA observed a water fountain in the off limit portion of the backyard. LPA informed Applicant about zero tolerance regulations related to bodies of water and advised Applicant to fill the fountain with rocks or plants to avoid collection of water. Toys and play structure in the outdoor area were age appropriate and in good condition.

Licensee has a working telephone in the home. LPA observed a fully charged 2A10BC fire extinguisher and a working smoke and carbon monoxide detector in the activity room. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant states that she does not have any weapons/ammunition or pets in the home. Cleaning products and first aid items were observed to be placed in high kitchen cabinets out of reach of children. LPA informed Licensee that the gate to the kitchen must remain closed at all times to make knives and sharp items inaccessible to children in care. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Applicant currently has four cribs with clear sides and six mats available for napping. LPA reminded applicant that all shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/removers must be placed inaccessible to the children. Applicant understands that she needs to notify Licensing if she wants to make an off-limit area available for the children. She also understands that she cannot use the area until it has been approved by Licensing.

Applicant states that she will provide lunch and snacks for the day care children. LPA reminded the Applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s). Filtered drinking water will be provided to children.

LPA observed postings near the entrance so it is visible to parents/authorized representatives. Applicant was 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TAN, XUEBING	FACILITY NUMBER: 434417439
	VISIT DATE: 10/22/2024

NARRATIVE

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Form of discipline will be to talk to children and help them understand. Applicant stated that she will not give time outs to children. Applicant understands 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. Applicant stated that in case of a communicable disease child will be isolated in the activity room or infant room, away from the other children, until parent pick up.

LPA discussed the requirements of Assembly Bill(AB) 633 with the Applicant. Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

LPA reviewed with applicant the Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant states that she will not provide transportation and LPA reminded applicant that children cannot be left in parked vehicles unattended at any time and that car seats shall only be used for transportation and shall not be used for sleeping.

LPA discussed the requirement for Licensee to be present at the facility 80 percent of the hours the facility is in operation and that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. Applicant understands the capacity options and understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TAN, XUEBING	FACILITY NUMBER: 434417439
	VISIT DATE: 10/22/2024

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Applicant understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

Incidental Medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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.

On this date, 09/17/2024, 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 address. 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.

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.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 Applicant, Xuebing Tan. LPA advised Applicant that a Large Family Child Care Home License will be issued upon submission of the following:

1. Yard Sketch (LIC 999A)

2. Picture proof of outdoor fountain filled with rocks or plants.
3. Manager's approval.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC809 (FAS) - (06/04)

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