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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420318
Report Date: 07/15/2022
Date Signed: 07/15/2022 03:52:37 PM


Document Has Been Signed on 07/15/2022 03:52 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:ZHANG, JUNFACILITY NUMBER:
013420318
ADMINISTRATOR:ZHANG, JUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 676-8125
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:14CENSUS: 13DATE:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Jun ZhangTIME COMPLETED:
04:10 PM
NARRATIVE
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On 07/15/2022, Licensing Program Analyst (LPA) Melanie Otsuji, met with licensee Jun Zhang for an UNANNOUNCED 1 YEAR REQUIRED INSPECTION. Also present during inspection was an assistant without a fingerprint clearance and 13 children (13 preschoolers) See 809-D for citations. 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. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible to children during today's inspection. Facility has a working smoke detector and working carbon monoxide detector, and working telephone. Facility last conducted a disaster drill was February 2022. Per licensee, there are no firearms in the home.

Incidental 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
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
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: ZHANG, JUN
FACILITY NUMBER: 013420318
VISIT DATE: 07/15/2022
NARRATIVE
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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.

The attached type A violations are cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.



Exit interview conducted and report was reviewed with the licensee Jun Zhang.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 07/15/2022 03:52 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:


This requirement is not met as evidenced by: Present during today's visit was S1. S1 does not have a criminal record clearance on file.
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 1 persons which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2022
Plan of Correction
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S1 left immediately and Licensee's fingerprint cleared spouse took over as assistant. Licensee is to send S1 to obtain the proper criminal record clearance and S1 is not to return until a clearance is received. LPA will return on another date to verify compliance with regulation.
Type A
Section Cited
CCR
102416.5(d)(2)
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in Licensee had 13 children present none of which are enrolled and attending transitional kindergarten or above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2022
Plan of Correction
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Licensee is to draft a plan to ensure that census remains at 12 unless the 13th and 14th children are enrolled and attending elementary school. LPA is to return on another date to ensure compliance with the above regulation.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
LIC809 (FAS) - (06/04)
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