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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421054
Report Date: 05/10/2022
Date Signed: 05/10/2022 03:18:42 PM


Document Has Been Signed on 05/10/2022 03:18 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:ZHAO, HUAFACILITY NUMBER:
013421054
ADMINISTRATOR:ZHAO, HUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 250-6760
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 10DATE:
05/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Hua Zhao- LicenseeTIME COMPLETED:
03:30 PM
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On 05/10/22, Licensing Program Analyst Briana Plumboy, met with licensee Hua Zhao (Mary) for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was 2 infants and 8 preschool age children, as well as fingerprint clear and associated assistant/ licensees husband Junshan Liu. The licensee's primary language is Mandarin. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:30am until 6:30pm.

The home is two levels. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, family room, dining room/nap room (located next to the living room), downstairs bathroom, and outdoor patio. The OFF LIMIT AREAS are the kitchen, laundry room, garage, and entire second level of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the dining room/nap room area. The PATIO play area is fenced and can be accessed through the family room. The patio area has wooden planks as a base and has two levels with 1 step. The facility barricades on limit areas with child safety gates and there is a gate at the bottom of the stairs to prevent access to stairs and second story of the home. There are toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. 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.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and assistant Shun Ping Zhao's CPR and First Aid certificates are current and expires 05/08/2023. The licensee, Yu Hong Shen, and Shun Ping Zhao are in compliance with the immunization law. The fireplace has a to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 12/23/21. The licensee and her husband currently have a waiver for mandated reporter training until it is available in English. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
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: ZHAO, HUA
FACILITY NUMBER: 013421054
VISIT DATE: 05/10/2022
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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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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



LPA discussed the safe sleep regulations with licensee Hua Zhao 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 Hua Zhao 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Hua Zhao.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC809 (FAS) - (06/04)
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