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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420349
Report Date: 07/29/2019
Date Signed: 07/29/2019 03:56:27 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LAI, DE ZHENFACILITY NUMBER:
013420349
ADMINISTRATOR:LAI, DE ZHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 559-3178
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 6DATE:
07/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:De Zhen LaiTIME COMPLETED:
04:15 PM
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 An unannounced Annual/Random site visit was conducted by LPA Susan Neeson. Met with De Zhen Lai. Visit began at 2:25 DeZhen Lai resides here with her mother and father-in-law, her husband and 4 adult children. All adults are fingerprint clear. CPR and First Aid are current for De Zhen Lai and her husband through 7/21. Present today are 3 school age children and three preschoolers.

Toured the home and yard. The family, most of it, resides in one half of a duplex on the property. Mr. Wu and Mrs. Lai have a bedroom in the front duplex on the part of the property which is used for child care. The child care areas are one bedroom, living/dining part of front duplex, bathroom in front duplex, front yard and driveway and back yard. There are plentiful toys and equipment for children in care. The former garage area is also used for play. The back duplex is off-limits. The home is heated by a wall heater which has a secure barricade. There are no bodies of water. The family has no pets. Fire and earthquake drills are being documented. The fire extinguisher is currently charged and the smoke alarm works. There is a carbon monoxide detector in the living/dining area. Children's records are being maintained. Required forms are posted. There is no body of water. De Zhen Lai states that there are no guns or firearms in the home or storage area. AB 1207 certificate is in file for Mr. Wu and De Zhen Lai.

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 and for day care updates visit www.myccl.gov
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LAI, DE ZHEN
FACILITY NUMBER: 013420349
VISIT DATE: 07/29/2019
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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:

The following were issued: Licensee rights, Safe Sleep for infants, Safe and Healthy Diapering, car seat information, fire and earthquake information, blue immunization form, Department Quarterly Updates, Flu prevention tips and AB 1207 information.

No deficiencies are observed. An exit interview was given.

SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2