013419802-5-30-2025-02-CC-JMAI-DH6PWH-20250530114047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419802
Report Date: 05/30/2025
Date Signed: 05/30/2025 11:43:00 AM

Document Has Been Signed on 05/30/2025 11:43 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SHANGGUAN, HUILIAN		FACILITY NUMBER:	013419802
ADMINISTRATOR/ DIRECTOR:	SHANGGUAN, HUILIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 463-7771
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	05/30/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Licensee Hiulan Shangguan		TIME VISIT/ INSPECTION COMPLETED:	12:00 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 05/30/2025 at approximately 9:00AM, Licensing Program Analysts (LPAs) Diana Campos and Jamel Maiwandi met with Licensee Hiulian Shangguan for an Unannounced Required 3 Year Inspection. Present during today’s inspection was the licensee, her spouse/assistant, and her minor son and daughter. All adults in the home are fingerprint cleared. Licensee stated there were 2 infants and 4 preschool age children present during the inspection and 6 children enrolled. The home is a two-story home that consists of four (4) bedrooms, three (3) bathrooms, kitchen, dining room, living room, office room, garage, and backyard. The entrance to the day care is the front door. The home was toured for Health and Safety Inspection. The home was observed to be orderly, with heating and ventilation for safety and comfort. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, and other items which could pose a danger to children are stored and inaccessible to children. Stairs are inaccessible to children. LPAs verified that the fire extinguisher is a 3A40BC and is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. The outdoor play area is a park located across the street, and licensee was reminded to ensure 100% visual supervision of children is conducted during outdoor play times. There is a fully stocked first aid kit. LPAs did not observe any bodies of water in or around home. There is central ventilation located on the ceiling and fireplace is inaccessible to children in living room. ON LIMIT AREAS: the dining room, family room, kitchen, bedroom #1(located near entrance of home), and bathroom (near entrance of home). OFF LIMITS: remainder of home is off limits. Report continues on page 2

Monica Mathur	TELEPHONE: (510) 421-3522
Jamel Maiwandi	TELEPHONE: (510) 622-2602
	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SHANGGUAN, HUILIAN	FACILITY NUMBER: 013419802
	VISIT DATE: 05/30/2025

NARRATIVE

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ISOLATION AREA: Bedroom #1

The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 04/07/2025. The licensee’s CPR and First Aid certificate is current and expires on May 31, 2025. Licensee was reminded that the Mandated Reporter training must renewed every two years. The Licensee was reminded of the responsibility as a mandated reporter. LPAs reviewed six children’s files at 10:00AM and obtained a current facility roster. The licensee is in compliance with the immunization law.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs 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.

Incidental Medical Services – IMS policy was discussed. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.
Report continues on page 3

SUPERVISOR'S NAME: Monica Mathur	TELEPHONE: (510) 421-3522
LICENSING EVALUATOR NAME: Jamel Maiwandi	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SHANGGUAN, HUILIAN	FACILITY NUMBER: 013419802
	VISIT DATE: 05/30/2025

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Huilian Shangguan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

No deficiencies were cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee Hiulian Shangguan
Report and Appeal rights were given to Licensee

Items needed are:
· Current mandated reporter training for licensee and spouse
· Spouse immunization record
· Locks on kitchen doors
· Infant sleeping logs and plans

SUPERVISOR'S NAME: Monica Mathur	TELEPHONE: (510) 421-3522
LICENSING EVALUATOR NAME: Jamel Maiwandi	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC809 (FAS) - (06/04)

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