013420114-1-27-2023-52-CC-MOTI-CNGSP9-20230127130246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420114
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:02:59 PM

Document Has Been Signed on 01/27/2023 01:02 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHEN, CHUN YA		FACILITY NUMBER:	013420114
ADMINISTRATOR:	CHEN, CHUN YA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 867-8100
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	14	CENSUS: 5	DATE:	01/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:27 AM
MET WITH:	Chun Ya Chen		TIME COMPLETED:	01:22 PM

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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on today's date, 01/27/2023, to conduct a Required - 1 Year inspection. LPA was met by Licensee Chun Ya Chen. Present during today's visit was a fingerprint cleared staff member and 5 preschool aged children. LPA conducted a health and safety inspection inside and outside.

ON LIMIT AREAS: classroom, hallway bathroom, living room (napping room) and back yard.

OFF LIMIT AREAS: All other rooms/areas are off limits. Off limit areas are barricaded by way of closed doors and or gates.

There are no pools, spas, or similar bodies of water on the premises. Per Licensee, there are no firearms or other dangerous weapons on site. Storage areas for poisons are inaccessible. Detergents and other cleaning compounds that can pose a danger to children are stored where inaccessible. A fully charged fire extinguisher, carbon monoxide detectors were observed to be operable. The home is kept clean, and orderly with ventilation for safety and comfort. LPA observed safe toys, play equipment and materials. The home has a working telephone on site. Outdoor play areas are fenced and supervision is provided while children are outside. On today's date, Licensee was within the proper capacity for their large family child care home license. All individuals present during today's date had the proper criminal record clearance. Each child's file contained the appropriate documentation. Licensee has current Preventative Health Training and Pediatric CPR/First aid which expires in 4/2023. Mandated reporter was taken on 7/17/2021.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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: CHEN, CHUN YA	FACILITY NUMBER: 013420114
	VISIT DATE: 01/27/2023

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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-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.

No deficiencies noted on today's date. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Chun Ya Chen.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC809 (FAS) - (06/04)

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