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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419651
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:19:05 PM


Document Has Been Signed on 05/25/2022 02:19 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:CHEN, LI YAN & CHEN, DAN DANFACILITY NUMBER:
013419651
ADMINISTRATOR:CHEN, LI YANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 352-8164
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 8DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee Chen, Dan Dan and Chen, Li yanTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Chen, Li Yan, and Chen Dan Dan and for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was both the Licensee supervising 2 infants and 6 preschoolers. Licensee is within capacity limits of a Large License. The hours of operation are 8:00AM- 6:00PM, Monday -Friday. The facility has a liability insurance through Kamper insurance.
On-limit-areas are : Living room, dining area, bedroom #1, bedroom #2, and bathroom #1, backyard.
Off Limit areas are: Master bedroom, bathroom #2, kitchen and garage
During inspection, Licensee requested to add bedroom #2 (daughter’s bedroom) into the day care. LPA inspected the bedroom for health and safety hazards, and it is free from defects or dangerous conditions. As of today, the bedroom #2 is approved for ON-LIMIT use.

LPA observed the following: Daycare Area is clean, orderly, and equipped with age appropriate toys and equipment for children, indoors and outdoors. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or Fireplace in the Daycare area. There are child size tables and chairs for snack and activities. There are ample of age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The napping room had cots in good condition and each child have their separate blankets. The blankets are washed weekly by the Parents. The outdoor play area is fenced, has adequate shade with cushioning under the play structure. Licensee states there are no guns or weapons of any kind in the home.

see next page...

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: CHEN, LI YAN & CHEN, DAN DAN
FACILITY NUMBER: 013419651
VISIT DATE: 05/25/2022
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Licensee’s CPR expires in 10/2022. Licensee conducted Licensee conducted last emergency drill on 03/17/2022 and is properly logged. Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children’s files. All the files are complete and up to date. All required postings are properly posted.

During Inspection, 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.

LPA discussed the safe sleep regulations with licensee 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 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.


Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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.

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

No deficiencies were cited today.

Exit interview conducted and report was reviewed with the licensee Chen, Dan Dan .

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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