013420318-7-7-2021-52-CC-MOTI-C4PRJP-20210707130416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420318
Report Date: 07/07/2021
Date Signed: 07/07/2021 01:04:21 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:	ZHANG, JUN		FACILITY NUMBER:	013420318
ADMINISTRATOR:	ZHANG, JUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 676-8125
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	14	CENSUS: 12	DATE:	07/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Jun Zhang		TIME COMPLETED:	01:05 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 7/7/21, Licensing Program Analyst (LPA) Melanie Otsuji, met with Licensee Jun Zhang for an UNANNOUNCED REQUIRED 1-YEAR INSPECTION. Present during this visit was a fingerprint cleared assistant, Zhuanqun Deng, and 12 children (4 infants 8 preschoolers). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:00am until 6:00pm. The main home is two stories. The home is neat and clean with heating and ventilation for safety and comfort. Parent's and children enter through the side yard gate. The ON LIMIT AREAS are living room in back of main house and additional dwelling unit (main child care room), nap room, bathroom in child care room, backyard and middle yard between main house and ADU. The OFF LIMIT AREAS are the upper floors of main home and garage. The ISOLATION AREA will be the area nearest the door to child care room. There are toys and learning equipment. There are no pools, hot tubs or any other bodies of water present in the on limit areas during the time of the inspection. The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and First Aid Kit. Both licensee and her assistants whom are present today have the required immunization's. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year. Facility roster reviewed and copy obtained. All REQUIRED forms are posted and visible for public review. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: ZHANG, JUN	FACILITY NUMBER: 013420318
	VISIT DATE: 07/07/2021

NARRATIVE

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Individual Medical Services (IMS) policy was discussed. 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

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

Effective August 1, 2003 California Law requires Family Child Care Home licensees 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. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

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