013419701-12-13-2022-52-CC-KPHN-CM3QKE-20221213111413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419701
Report Date: 12/13/2022
Date Signed: 12/13/2022 11:14:26 AM

Document Has Been Signed on 12/13/2022 11:14 AM - 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:	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: 9	DATE:	12/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Flora Young		TIME COMPLETED:	11:30 AM

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 12/13/2022 approximately 9:10AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Flora Young. Present for this inspection was 9 preschool aged children along with a fingerprinted and associated helper. Also residing in the home is the licensee's fingerprinted and associated husband, "Ricky" who also assists her during day care hours too. Per licensee, both her adult children sometimes reside at 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, "bonus room" across from the family room, the added bathroom in bonus room, backyard, and half of kitchen space, living room (used as isolation area), and front yard OFF LIMITS: garage, other half of kitchen, two side yards, outdoor shed, 3 bedroom, 1 master bedroom, and master bathroom. 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. At 9:20AM, LPA observed 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 located in the kitchen area, carbon monoxide, and smoke detector that meets State standards. The home has a wall heater and fireplace but is blocked off and are not in use as the facility also has central heating; there is also a telephone present at the facility. Per licensee, there are no firearms or pets or smoking at the facility. The licensee conducts and documents fire drill log indicates a drill was conducted 11/22/22. All required licensing documents are posted and visible for public review. Per licensee, children would sleep on mats and blankets and bedding would be given and cleaned every Friday. 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: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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: YOUNG, FLORA	FACILITY NUMBER: 013419701
	VISIT DATE: 12/13/2022

NARRATIVE

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At 9:30am, LPA toured the front and back yard area with licensee's husband. Both areas are fully fenced, gated, and supervised by facility staff. There is no swimming pool, hot tubs, or bodies of water present at the facility. Side yards and outdoor shed are closed and off limits to children; per licensee's husband, they would go through the "bonus room door" , which is located in the right side yard only used for emergency purposes. Children would only play on the grass area whenever weather permits. At 10:00am, 6 children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee and staff have proof of the required immunization. The licensee and staff members have required mandated reporter training completed; licensee has last completed her mandated reporter training on 06/09/2022. CPR and First Aid training are also updated for both licensee and staff members; licensee has valid CPR and First aid card as of 07/10/2021 to 07/01/2023. Licensee also has liability insurance from Acord that is valid on 09/01/2022 to 09/01/2023 that meets the minimum requirement. LPA also reviewed one child's medication and documentation; LPA advised licensee to obtain a new medication as the one kept at the facility is expired; licensee understood.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Flora Young

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.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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: 12/13/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. The facility is following and have developed 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.”

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.

Licensee 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. 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. Licensee 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.

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: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

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