013419701-11-22-2021-52-CC-KPHN-C8ZTS4-20211122135832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419701
Report Date: 11/22/2021
Date Signed: 11/22/2021 01:58:44 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:	YOUNG, FLORA		FACILITY NUMBER:	013419701
ADMINISTRATOR:	YOUNG, FLORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 656-5977
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	14	CENSUS: 13	DATE:	11/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Flora Young		TIME COMPLETED:	02:25 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 11/22/2021 approximately 11:30am Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Flora Young. Present for this inspection was 13 preschool aged children and unassociated helper, Nancy Jayne. Also residing in the home is the licensee's fingerprinted and associated husband, Wing Ken Fan (Ricky) who also assists her during day care hours. Per licensee, the Licensee's adult children do not reside in the home. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am-5:30pm. ON LIMITS: family room #1, the added on daycare room with bathroom, backyard, and half of kitchen space, living room (used as isolation area) OFF LIMITS: garage, other half of kitchen, front yard, two gated side yards, locked backyard shed, and four bedrooms. Off limit areas are inaccessible by closed and/or locked doors, gates, and visual supervision. The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. A child safety gate is required at the stairway as the Licensee is using a gate to keep children in the family room area. There were age appropriate toys that were observed to be safe and in good condition. No toxins, medicines, and hazardous items were inaccessible during today's inspection. A fully charged 2A10BC fire extinguisher, carbon monoxide and smoke detector that meets State standards. The home has a wall heater but is blocked off by a barrier. Per licensee, there are no firearms or pets or any bodies of water in the home. The licensee conducts and documents fire drill log indicates a drill was conducted 5/20/21. All required licensing documents are posted and visible for public review.Licensee, her husband, and two fingerprinted and associated helpers (Sammi Li and Sarah J. Sanchez) has required mandated reporter training that is completed as of 06/03/2020. Licensee and her helper (Sarah Sanchez) has CPR and First Aid training are also updated as of 07/10/2021 and are valid until 7/10/2023. SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

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: YOUNG, FLORA	FACILITY NUMBER: 013419701
	VISIT DATE: 11/22/2021

NARRATIVE

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At 12:00pm, six children's and employee files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee has proof of the required immunization. LPA reminded licensee that she has to get all employees and volunteers need to obtain clearance or transferred fingerprints and be associated to her facility prior to employment. As of today, 11/22/2021, LPA informed licensee that she is cited for not having an associated and fingerprinted helper to her facility; licensee admits she had removed her awhile back and only came today to help since her two helpers could not work today.

Exit interview conducted. Appeal rights and site visit was given to licensee to post for 30 days.

This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated 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.”

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

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: YOUNG, FLORA	FACILITY NUMBER: 013419701
	VISIT DATE: 11/22/2021

NARRATIVE

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LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Facility Representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Facility Representative was reminded that California Law requires licensed Child Care Centers 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

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/process.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

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: YOUNG, FLORA	FACILITY NUMBER: 013419701
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

CCR

102370(d)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: 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 an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/23/2021
	Plan of Correction
1 2 3 4	Licensee understands she has to have any adults who work with children would need to be fingerprinted Appeal Rights and instructions were given Nancy Jayne cannot provide care to children until she gets fingerprinted and associated to facility

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: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021

LIC809 (FAS) - (06/04)

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