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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419929
Report Date: 09/22/2021
Date Signed: 09/22/2021 10:48:25 AM

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:WANG, YIHANFACILITY NUMBER:
013419929
ADMINISTRATOR:WANG, YIHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 828-3888
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:14CENSUS: 5DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Yihan WangTIME COMPLETED:
11:00 AM
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On September 22, 2021, at 8:30 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Required Inspection and met with licensee, Yihan Wang. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was licensee's fingerprint cleared assistant T. Chen. There were 5 children present, two (2) infants, and three (3) preschoolers. The facility was toured to conduct a health and safety inspection. The facility plans to operate between the hours of 7:00 AM-6:00 PM, Monday -Friday

On-limit-areas are the: Living and dining room, kitchen, bathroom next to laundry room, family room

Off-limit-areas are : Bedroom next to laundry room, Entire second level of home, garage, and backyard

This two-story home ,which is neat and clean with heating and ventilation for safety and comfort. The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be a section of the family room, away from other children in care. There's a gate at the bottom of the stairs, leading from the living room to the upper level of home. The outdoor play area , the Licensee states she will utilizes the park complex across the street from her facility. the licensee was reminded to have 100% supervision when away from her facility at all times.

There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

See 809-Continuation
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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: WANG, YIHAN
FACILITY NUMBER: 013419929
VISIT DATE: 09/22/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a 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

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-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 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.

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.

There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee , Yihan Wang.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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: WANG, YIHAN
FACILITY NUMBER: 013419929
VISIT DATE: 09/22/2021
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The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and telephone. There are two fireplaces which are blocked to prevent access by children.

Per licensee, there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. All required forms are posted and visible for public review.

At 9:15 AM LPA requested and reviewed the files of three (3) children in care. The facility roster was reviewed, and copies was obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 08/30/21. The licensee is in ratio today. The licensee is aware when the mandated training is available in her native language she must complete and receive a certificate of completion and mandated reporter training. The training can be found at mandatedreporterca.com. Licensee's CPR and First Aid certificate is current and expires 9/4/23. All required forms are posted and visible for public review.

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

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

The licensee was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).


See 809 C

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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