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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420709
Report Date: 06/22/2023
Date Signed: 06/22/2023 03:45:59 PM


Document Has Been Signed on 06/22/2023 03:45 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
OAKLAND SOUTH EAST, 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: 6DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Muilam NgTIME COMPLETED:
03:55 PM
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On June 22, 2023 at approximately 11:40am Licensing Program Analyst (LPA) Haderer met with the licensee Muliam Ng 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, and 6 children in care (4 infants, 1 two and half years old; 1 three years old). The home is in ratio. The hours of operation are Monday - Friday 8:30am 6:00pm.

The Licensee only speaks Cantonese, LPA spoke with licensee’s granddaughter by telephone to help interpret and assisted during the inspection.

The facility is a single-story home consisting of a kitchen, living room, family room, four bedrooms, two bathrooms, 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 spaces. Licensee asked they be added as on limits area and also include two formerly off-limits additional bedrooms in the on limits of the home. LPA inspected all the rooms and approved the changes. 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, the room addition off the family room and the master bedroom on the right side of the hall; the bedroom on the left side of the hall; backyard covered patio area.
OFF LIMITS areas include the back two bedrooms down the hall to the and left again down the hall pat the house bathroom; attached two-car garage backyard area beyond the covered patio area. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the on-limits child care room away from the other children in care.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: NG, MUILAM
FACILITY NUMBER: 013420709
VISIT DATE: 06/22/2023
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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.
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. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

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. Licensee was reminded that CPR/1st Aide certificate is required to be renewed every two years.
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; the last drill conducted on May 30, 2023. 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). There is no fireplace in the home



Children’s files were reviewed. The child care facility roster was available, the dates children left has not been updated, this is a technical violation. All records were complete and in good order. Infants had signed and dated Infant Safe Sleep Plans (LIC9227) and sleep logs were maintained for 2 of the 4 infants under 12 months old. This is a technical violation. A napping child was in a room with a closed door, this is a deficiency - see LIC 809D

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: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: NG, MUILAM
FACILITY NUMBER: 013420709
VISIT DATE: 06/22/2023
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LPA discussed the safe sleep regulations with licensee Muilam Ng 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 was one deficiency issued today, see LIC809D:

- A sleeping infant was in a room with the door closed.

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.



Two technical violations were issued. Please see LIC 9102 for Advisory Notes.

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.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/22/2023 03:45 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: NG, MUILAM
FACILITY NUMBER: 013420709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that LPA found a shut door to where infant was sleeping which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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LPA opened the door and advised that the door must always remain open if a child is napping in another room.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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