013417860-8-23-2021-52-CC-BPLY-C66T7R-20210823142912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417860
Report Date: 08/23/2021
Date Signed: 08/23/2021 02:29:17 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:	LI, EVA QI HUA		FACILITY NUMBER:	013417860
ADMINISTRATOR:	LI, EVA QI HUA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 827-2880
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94546
CAPACITY:	14	CENSUS: 9	DATE:	08/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Eva Qi Hua Li		TIME COMPLETED:	02:45 PM

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 08/23/21, Licensing Program Analyst Briana Plumboy, met with licensee Eva Qi Hua Li for an UNANNOUNCED 1 YEAR REQUIRED RANDOM INSPECTION. Present for this visit was licensees fingerprint clear assistant Quli Li, 4 infants, 4 preschool age children, and 1 school age child. The inspection was translated in Cantonese using a translator from Language Links #12227. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:00am until 6:00pm. The home is two levels. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, dining room, the bedroom located on the right side of the hallway, and the hallway bathroom. As of 8/23/21, the backyard is included in the on limits areas. There is a in law unit located in the backyard and is off limits to children in care. The OFF LIMIT AREAS are the bedroom on left side of the hallway, the kitchen, the master bedroom with master bathroom located off the kitchen, and the garage. The children in care walk through the dining room to access the backyard. which will be inaccessible by closed and/or locked doors and visual supervision. As of 07/17/19, the dining room and a portion of the backyard are on limits. The ISOLATION AREA will be the family room. The portion of the BACKYARD which is utilized for children in care is located behind the white fenced and located at the far end of the yard. There are toys and learning equipment. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee, her husband Jim Liu, and assistant Qili Li completed CPR/First Aid training and their certificates expire 07/2023. The licensee and her assistant have waivers for mandated reporting training until it is available in Cantonese. The licensee and her assistant are in compliance with the provider immunization law. According to the licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 06/14/21. The licensee provided LPA Plumboy with a copy of her facility roster. 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 Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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: LI, EVA QI HUA	FACILITY NUMBER: 013417860
	VISIT DATE: 08/23/2021

NARRATIVE

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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

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. This entire report was read to licensee by LPA Plumboy. Appeal rights provided and discussed. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

LIC809 (FAS) - (06/04)

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