Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413322
Report Date: 08/06/2015 12:00:00 AM
Date Signed 08/06/2015 04:26:44 PM

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:JIA, RONGMEIFACILITY NUMBER:
434413322
ADMINISTRATOR:JIA, RONGMEIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 858-3510
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:14CENSUS: 11DATE:
08/06/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rongmei JiaTIME COMPLETED:
04:30 PM
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(3) Licensing Program Analyst (LPA) Shan Tan met with Licensee Rongmei Jia and conducted an annual random visit today. Present in the home were licensee, licensee's helper and 11 day care children. The children were 4 infants and 7 preschoolers. Licensee's certifications for CPR and First Aid are current which expire on 6/30/17. Licensee stated days and hours of operation is M-F from 8:30 am to 6:30 pm. LPA toured the indoor and outdoor areas. Off limit areas in the home include master bedrooms & bathroom, son's bedroom, kitchen and both side yards. Children play in the fenced area in the backyard. LPA observed a fully-charged 2A10BC fire extinguisher, working smoke detector, a functioning carbon Monoxide and a screened fireplace. Cleaning products and hazardous were inaccessible to children. Licensee stated that she had no pets, no weapons or firearm in the home. LPA reviewed children's files and verified the staff records completed. The children's roster is up-to-date. Licensee understood that no smoking is allowed around the children or while daycare children are present and understood that children's personal rights should not be violated and no corporal punishment. She is using time-out as a form of discipline. Licensee does not transport children but she is aware of the safety seat belt/car seat laws and insurance requirements. A Family Child Care Home packet was reviewed with licensee. Licensing information sheet regarding the Department's website: www.ccld.ca.gov to obtain forms and regulations CCR, Title 22 was also provided. LPA reminded licensee of the applicable $100 civil penalty per person per day, a maximum of $500 per person (if cited again within 12 months maximum of $3,000 per person) for those adults who have not received fingerprint clearances, are not associated to the license who come in contact with or provide care and supervision to the children. The following was also discussed, isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills-practiced at least twice a year and documented.The last drills was done on 6/19/15. LPA discussed the requirements of AB 633 to licensee and provided her the fact sheet and a copy of Acknowledgement of receipt of Licensing Reports (LIC 9224). Zero Tolerance with $150 civil penalty and Incidental Medical Services also explained to licensee.
A review of staff records during today's visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
No deficiency was cited today.
Notice of Site Visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shan TanTELEPHONE: (408) 334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2015
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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