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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414823
Report Date: 02/28/2023
Date Signed: 02/28/2023 12:29:52 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/28/2023 12:29 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:DO, KATIE HOAFACILITY NUMBER:
013414823
ADMINISTRATOR:DO, KATIE HOAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 709-5010
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 11DATE:
02/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Katie Hoa Do- LicenseeTIME COMPLETED:
12:40 PM
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On 2/28/23 at 11:00am, Licensing Program Analyst Briana Plumboy met with licensee Katie Hoa Do for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was 11 preschool age children, and fingerprint clear assistants Marianna Zuniga Avalos and Adriana Garcia. The home was toured to conduct a Health and Safety Inspection. The family child care currently operates Monday through Friday from 7:30am until 5:30pm.

The home is two stories. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the kitchen/dining/family room combo, the living room, the downstairs bedroom, and the two bathrooms located on the first level of the home. The OFF LIMIT AREAS are the laundry room, the walk in closet located inside the first floor bedroom, and the entire second level of the home which will be inaccessible by closed and/or locked doors and visual supervision. There is a gate located at the bottom of the stairs to prevent access to the upper level of the home. The ISOLATION AREA will be the living room. The FRONTYARD play area is completely fenced. The licensee and assistants are aware there must be 100% visual supervision at all times when the children are playing in the frontyard. There are toys, play equipment, and learning materials. There is a hot tub located in the backyard which is an off limits area. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection.
The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee CPR and First Aid certificate is current and expires 09/21/23 and assistant Marianna Zuniga Avalos has a current CPR and First Aid certificate which expires 08/05/23. The licensee's mandated reporter training is current and she received her certificate on 3/6/22 assistant Marianna received her certificate on 02/24/22, and assistant Adriana Garcia received her certificate of completion on 07/29/21. The licensee and her assistants present today are in compliance with the immunization law which pertains to providers. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills at least twice a year with the last one conducted on 9/13/22. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: DO, KATIE HOA
FACILITY NUMBER: 013414823
VISIT DATE: 02/28/2023
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Incidental Medical Services (IMS) policy was discussed. 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)/ (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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Katie Hoa Do and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Katie Hoa Do 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.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Katie Hoa Do.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC809 (FAS) - (06/04)
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