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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420709
Report Date: 05/20/2022
Date Signed: 05/20/2022 01:31:09 PM


Document Has Been Signed on 05/20/2022 01:31 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:NG, MUILAMFACILITY NUMBER:
013420709
ADMINISTRATOR:NG, MUILAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 706-8378
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 8DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Muilam Ng and Weiqi MeiTIME COMPLETED:
01:45 PM
NARRATIVE
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On May 20, 2022 at approximately 11:00am Licensing Program Analyst (LPA) Haderer met with the licensee Muliam Ng and his granddaughter (as interpreter) for the purpose of conducting 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, his fingerprint and TB cleared wife, their adult TB and fingerprint cleared granddaughter and 8 children in care (3 infants, 3 two years-old; 1 three years-old; 1 four years-old). The home was in ratio today. The hours of operation are Monday -Thursday 8:30am 6:00pm.

The Licensee only speaks Cantonese, LPA and English-speaking granddaughter helped interpret and assisted during the inspection.

The facility is a single-story home consisting of a kitchen, living room, family room, four bedrooms, one bathroom, an attached two-car garage and an enclosed/fenced private backyard. The home had an addition in 2007 to the family room (not on facility sketch), with a sliding glass door that leads the three separate off-limits spaces. The home is neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials or toxins accessible to children today.

ON LIMITS area includes the living room, family room, and main house bathroom at the end of the hall,
OFF LIMITS areas include all four bedrooms, kitchen, attached two-car garage, room addition off the family room and outdoor backyard area. Per the licensee, the ISOLATION AREA will be in the on-limits child care room away from the other children in care.

LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. There are age appropriate toys, learning materials, and equipment that appear to be safe and in good condition.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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 4


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: NG, MUILAM
FACILITY NUMBER: 013420709
VISIT DATE: 05/20/2022
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There are ample age-appropriate toys and learning materials inside and outside the home. The outdoor play area has ample toys that are free from defects and dangerous conditions. Per licensee, there are no firearms in the home. Drop-down cribs are not allowed at the day-care facility.

The licensee and helper's Health and Safety training is completed, and CPR and First Aid certificate both expire on October 30, 2023. Licensee does not have mandated reporter training done until it becomes available in Cantonese language.

The licensee, and helper, are both in compliance with TB immunization with negative results. The licensee is up to date with the immunization laws which pertains to day care providers. Records were present showing Tdap and MMR immunization .

Fire/disaster drill log was available showing the last drill conducted on May 4, 2022. The home has a fully charged 2A10BC fire extinguisher mounted in the family room. The home has working fire alarms (tested) and a working carbon monoxide detector (tested). The fireplace in the home has been removed and a window has been added in its place.



At 12:00pm, children’s files were reviewed. All records were complete and in good order with the exception of the Infant Safe Sleep Plan (LIC9227) for one 11 month-old child and sleep logs were not maintained for 3 out of the 4 infants in care. See LIC809D for deficiency.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: NG, MUILAM
FACILITY NUMBER: 013420709
VISIT DATE: 05/20/2022
NARRATIVE
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LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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 were 2 deficiencies issued today, see LIC809D for deficiencies. The report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the licensee Muilam Ng and Weiqi Mei.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/20/2022 01:31 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: NG, MUILAM
FACILITY NUMBER: 013420709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Licensee had sleep log for one infant (11 months old) but not the other 3 infants between age 12-24 months which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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Licensee will begin to maintain sleep logs for all infants in care from birth to 24 months and keep these records for three years.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that a signed LIC9227 Infant Safe Sleep Plan was not available of one 11-month old infant in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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Licensee will obtain a signed LIC9227 Infant Safe Sleep Plan from the parent of the child. Going forward, Licensee will also ensure that these forms are completed and available for all infants in care from birth to 12 months.

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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4