013420743-8-23-2021-52-CC-RHAR-C66QCB-20210823120253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420743
Report Date: 08/23/2021
Date Signed: 08/23/2021 12:03:02 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:	TAN, YUE SHAN		FACILITY NUMBER:	013420743
ADMINISTRATOR:	TAN, YUE SHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 378-5118
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 9	DATE:	08/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Yue Shan Tan		TIME COMPLETED:	12:11 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 August 23, 2021 at approximately 10:13 am Licensing Program Analyst (LPA) Haderer arrived for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, her two fingerprint and TB cleared assistants and 9 children in care (2 infants; 5 three-years old; 2 four-years old). The licensee is in ratio today. The hours of operation are Monday through Friday, 8:00am to 6:00pm. The facility is a single-story home with 4 bedrooms 2 bathrooms, kitchen, living room, (day care area), family room (day care play room) an attached 2-car garage, side and backyard area. Licensee rents the home, landlord notification form LIC 9151 in place. The home is neat and clean with central heating and ventilation for safety and comfort. The outdoor play area is fenced, has tarps for shade, and covered with artificial turf for cushioning and observed to be free from defects and dangerous conditions. There were ample age appropriate toys inside and outside that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. ON LIMITS: Living room (day care area), family room (day care area), Bedroom #1 (west side of home) for napping and the attached bathroom, fenced-in backyard area. OFF LIMITS: Kitchen, Bedrooms 2, 3 and 4 (all on east side of home), main house bathroom, areas outside of fenced in area of backyard (including side yard) and attached 2-car garage. The off-limits areas are inaccessible by closed and/or locked doors, child gates and visual supervision. At 11:15am the facility and children’s files were reviewed and examined for compliance to Title 22 regulations. The facility roster was reviewed, and a copy obtained.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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: TAN, YUE SHAN	FACILITY NUMBER: 013420743
	VISIT DATE: 08/23/2021

NARRATIVE

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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. Disaster drills are conducted every 6 months, the last one was completed on 7/30/2021. The home has a fully charged 3A40BC fire extinguisher stored in the kitchen. There is a working telephone, a smoke detector and carbon monoxide detectors (tested and functioning). The home does not have a fireplace. Per licensee, there are no firearms in the home.

The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 7/10/2023. The helper's Pediatric CPR and First Aid certificate is current and expires 7/10/2023. The licensee and her helpers completed and received a certificate in Chinese language mandated reporter training (verified AB1207), expire on 7/17/2023. Licensee and helpers are all in compliance with the immunization laws which pertains to day care providers.

LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

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

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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
LPA reviewed guidance on operating safely during the Covid pandemic, including all adults and children over the age over age two must wear face coverings while indoors. Posters were present and the checking in process of children was observed. There were no deficiencies cited today, the facility report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. Exit interview conducted with Yue Shan Tan. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

LIC809 (FAS) - (06/04)

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