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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417860
Report Date: 08/08/2022
Date Signed: 08/08/2022 12:53:16 PM


Document Has Been Signed on 08/08/2022 12:53 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:LI, EVA QI HUAFACILITY NUMBER:
013417860
ADMINISTRATOR:LI, EVA QI HUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 827-2880
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:14CENSUS: 9DATE:
08/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:14 AM
MET WITH:Eva Qi Hua Li- LicenseeTIME COMPLETED:
01:02 PM
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On 08/08/22 at 11:14am, 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 Brenda Liu, 4 infants, 5 preschool age children, and licensees fingerprint clear and associated husband Jim Liu and father. 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. 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 licensees fire extinguisher was last inspected on 6/28/22 by ACME Fire Extinguisher Company. 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 07/09/22. 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 NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2022
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: 08/08/2022
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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 Eva Qi Hua Li 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 Eva Qi Hua Li 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 Eva Qi Hua Li.

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

DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
LIC809 (FAS) - (06/04)
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