013419651-4-13-2023-52-CC-AELT-CQUSSX-20230413140841

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419651
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:10:12 PM

Document Has Been Signed on 04/13/2023 02:10 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHEN, LI YAN & CHEN, DAN DAN		FACILITY NUMBER:	013419651
ADMINISTRATOR:	CHEN, LI YAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 819-1881
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94578
CAPACITY:	14	CENSUS: 9	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Li Yan Chan and Qi Chen - Dan Dan Chen via Phone		TIME COMPLETED:	02:30 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	Licensing Program Analyst (LPA) Andrew Elliot and Licensing Program Manager Wynn Norona met with Licensee Chen, Li Yan 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 3 infants and 6 preschoolers, employee Guohung He and Qi Chen. Licensee Dan Dan was not present at the facility, but assisted with translation and provided information via phone call and face time. Licensee is within capacity limits of a Large family home at the time of the inspection. Gouhung He left the facility at 10:15 part way through the inspection. License stated that 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 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 3A40BC model fire extinguisher that meets the minimum requirements. There are no bodies of water nor 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. LPA observed that there were 7 cots and 2 cribs the facility. Only 2 infants sleep in cribs, while 1 infant, child # 1 sleeps in a cot. At the time of inspection, child 1 is 20 months of age, and lacks documentation that they are able to climb out of a crib. A technical violation will be issued for this lack of documentation.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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 in 4 out of 4 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Licensee will send LPA a compelted proof of mandated reporter training for all staff associated with the facility via email by 05/01/2023. Proof of completion will be send via pdf to andrew.elliott@dss.ca.gov.

Section Cited

Personnel Records


	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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 4 out of 4 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Licensee will send LPA a compelted proof of mandated reporter training for all staff associated with the facility via email by 05/01/2023. Proof of completion will be send via pdf to andrew.elliott@dss.ca.gov.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Licensee will send LPA a compelted proof of mandated reporter training for all staff associated with the facility via email by 05/01/2023. Proof of completion will be send via pdf to andrew.elliott@dss.ca.gov.

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
	VISIT DATE: 04/13/2023

NARRATIVE

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The outdoor play area is fenced, has adequate shade but it is currently off limits. Children instead play in a outdoor area in the front of the home, which is neat, clean, fenced off, and includes a shade area. There Licensee states there are no guns or weapons of any kind in the home.

Licensee’s CPR expires in 10/2023. Licensee conducted last emergency drill
on 1/23/2023 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-s
leep 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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
	VISIT DATE: 04/13/2023

NARRATIVE

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During the visit, LPA observed that staff 2, 3 and 4 did not have any proof of mandated reporter training on file. Staff 1 had a mandated reporter training certificate issued in 2017, which is currently expired. LPA observed that not staff present at the facility had proof of current mandated reporter training. A type B citation will be issued for this failure to document.
During the visit, LPAs observed that staff 4 did not have any immunization records or TB test on file. This is a violation that poses a potential risk to the health of children in care, therefore a type B violation will be cited.
Training can be taken online at www.mandatedreporterca.com
There are 2 Type B Violations cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conduct.

1 Type B violation will be issued for employee 1 lacking a current proof of mandated reporter training certification and employees 2, 3, and 4 lacking proof of completion of mandated reporter training.
1 Type B violation will be issued for employee 4 not having proof of vaccination for MMR vaccine on file, as well as for a lack of TB test on file.
There is 1 Technical Violations Cited today, This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conduct.
1 Technical Violation will be issued for not having sufficient cribs for sleeping infants.

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.

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

.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
	VISIT DATE: 04/13/2023

NARRATIVE

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SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, LI YAN & CHEN, DAN DAN	FACILITY NUMBER: 013419651
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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