013415955-11-12-2021-52-CC-RHAR-C8PSZF-20211112131903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013415955
Report Date: 11/12/2021
Date Signed: 11/12/2021 01:19:21 PM

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:	HAN, LYNN		FACILITY NUMBER:	013415955
ADMINISTRATOR:	HAN, LYNN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 744-1668
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	14	CENSUS: 4	DATE:	11/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Lynn Han		TIME COMPLETED:	01:25 PM

NARRATIVE

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On November 12, 2021 at approximately 9:40am Licensing Program Analyst (LPA) Russ Haderer arrived and met with licensee Lynn Han for the purpose of conducting an unannounced annual inspection for health and safety. Living in the home is the licensee, her TB test and fingerprint cleared husband who was also present for the inspection. Upon arrival there was 4 children in care, (1 infant 23 month and 3 toddlers). The facility is in ratio today. The hours of operation are Monday-Friday, 8:00am to 6:30pm. Due to licensee's limited English, the CTS Translation Link was used.

The facility is a single-story home on a corner lot with a small front and back yard area and a 2-car attached garage. There were a few changes to the on-limits and off-limits areas, an updated LIC999 sketch will be sent into the licensing office. The Licensee also stated she is planning to retire and move to a new home in March 2022. Licensee was advised that in March, she should return her license to the Oakland office and write “no longer providing childcare” and to sign and date the document.

ISOLATION AREA will be in one of the play area away from other children in care. The child can be watched and taken care of in that area until their parent arrives.

On-limit-areas include: Living room, family room, bedroom on the left side (for napping) enclosed patio day care area in the back yard, ½ bath and enclosed backyard patio area.

Off-limit-areas include: The rest of the home is off limits (bedrooms, kitchen and 2-car garage). All off limit areas are inaccessible by closed and/or locked doors and visual supervision.

There were ample age appropriate toys that were observed to be safe and in good condition. The home is neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection. Per licensee, there are no firearms in the home. There is a permanently closed off fireplace in the family room (day care area).

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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: HAN, LYNN	FACILITY NUMBER: 013415955
	VISIT DATE: 11/12/2021

NARRATIVE

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There is a fully charged 2A10BC fire extinguisher located in the enclosed backyard play area. The facility has a working smoke and carbon monoxide detectors. The licensee conducts and documents Fire/Disaster Drills at least twice a year, however, he log indicates the last drill was conducted 3/9/2021 (this is a deficiency). All required licensing documents are posted and visible for public review.

At 10:50 am children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. All files were complete and the licensee is in ratio today.

The licensee’s Pediatric CPR/First Aid certificate is current and expires 3/20/2023. Mandated reporter training not completed until it becomes available in Chinese language. Licensee, and all adults living in the home are in compliance with immunization law which pertains to day care providers,

LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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: HAN, LYNN	FACILITY NUMBER: 013415955
	VISIT DATE: 11/12/2021

NARRATIVE

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LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

There was one deficiency issued during today’s inspection, see LIC809-D: This report will remain on file for 3 years.

A review of operating safely during the Covid-19 pandemic (RAST) was conducted.

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

Exit interview conducted and report was reviewed with the licensee Lynn Han.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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: HAN, LYNN	FACILITY NUMBER: 013415955
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the last drill was completed on March 9, 2021 more than 6 months has passed which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/15/2021
	Plan of Correction
1 2 3 4	Licensee will complete a drill on Monday, November 15, 2021

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

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