<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421229
Report Date: 12/09/2019
Date Signed: 12/09/2019 12:07:22 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:HUANG, SHIRLEYFACILITY NUMBER:
013421229
ADMINISTRATOR:HUANG, SHIRLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 276-0269
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:14CENSUS: 9DATE:
12/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Shirley HuangTIME COMPLETED:
12:30 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
Licensing Program Analysts (LPAs) Junell Chen and Julia Placencia arrived for an unannounced Annual/Random Inspection, and met with Licensee Shirley Huang. Present for this inspection was fingerprint cleared helper Jing Zhao. Present were two infants and 7 preschoolers. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30am to 5:30pm.

ON LIMITS: The entirety of the first floor with the exception of the garage. The kitchen, living room, bathroom, and backyard.
OFF LIMITS: The entirety of the second floor. The garage.

The garage has not been approved by the Fire Department's latest fire clearance on file for day care at all. At the time of inspection, Licensee is using garage as an on-limits area to the day care. An abundance of toys and children friendly materials were found in the garage; it is not being used as a mere extension to the day care. Licensing was not notified of Licensee's changes pertaining to making the garage to an on limits area.


The home is two levels, which are neat and clean, with heating and ventilation for safety and comfort. The stairways had child safety gates in place. The home does have a backyard. The isolation area will be in the kitchen . There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Fire extinguisher, carbon monoxide and smoke detector meet State Fire Marshall standards. Per licensee, the heater vents are situated on the walls. Per licensee, there are no firearms in the home. There is a pet dog in the home. All required licensing documents are posted and visible for public review.

***Continued on LIC809C***
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
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 5
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: HUANG, SHIRLEY
FACILITY NUMBER: 013421229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2019
Section Cited

1
2
3
4
5
6
7
102416.3 Alterations to Existing Buildings or Grounds (a)Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: 6) Any change from an area of the family child care home previously identified as "off limits"
8
9
10
11
12
13
14
to an area where care and supervision will be provided to children in care. This requirement was not met as evidence by: based on observation. LPAs observed garage has been converted to a day care room. Licensing was not notified of the change. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
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.
Type B
12/16/2019
Section Cited

1
2
3
4
5
6
7
102423 Personal Rights (a)Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2)To receive safe, healthful,
8
9
10
11
12
13
14
and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidence by: based on observation. LPAs observed a child in high chair for prolonged period of time without eating. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
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.
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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: HUANG, SHIRLEY
FACILITY NUMBER: 013421229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2019
Section Cited

1
2
3
4
5
6
7
102418 Immunizations (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
8
9
10
11
12
13
14
This requirement was not met as evidence by: based on observation. LPAs observed missing immunization records in children's files. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
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.
Type B
12/16/2019
Section Cited

1
2
3
4
5
6
7
102369 Application for Initial License (9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
8
9
10
11
12
13
14
This requirement was not met as evidence by: based on observation. LPAs observed missing TB records in assistant Jing Zhao's files. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
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.
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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: HUANG, SHIRLEY
FACILITY NUMBER: 013421229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2019
Section Cited

1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
8
9
10
11
12
13
14
This requirement was not met as evidence by: based on observation. LPAs observed missing facility roster. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
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.
Type B
12/16/2019
Section Cited

1
2
3
4
5
6
7
102421 Child's Records (b) The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).
8
9
10
11
12
13
14
This requirement was not met as evidence by: based on observation. LPAs observed missing child file for a child in care today. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
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.
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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: HUANG, SHIRLEY
FACILITY NUMBER: 013421229
VISIT DATE: 12/09/2019
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
26
27
28
29
30
31
32
During the time of inspection, 9 children's files were reviewed. There is one missing child's file for one child in care at the time of inspection. The facility roster was not presented nor reviewed. The licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current and expires 04/20/21. Licensee has not completed the mandated reporter training. Assistant Jing Zhao does not have proof of all required immunizations. Last disaster drill was logged on 10/22/19. It was noted that drills were being conducted on a yearly basis, not at least every 6 months. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle.

The following deficiencies were observed during today's inspection:
1. LPAs observed that the garage is being used as an on-limits area to the day care. Fire clearance did not approve garage.
2. LPAs observed that during the time of inspection, one child was being left on the high chair for a prolonged period of time. Child was observed to be finished with food and did not want any more. The time span of the child being in the high chair was observed to be over an hour.
3. LPAs observed that most children files did not have required immunizations.
4. LPAs observed that assistant Jing Zhao did not have all required immunizations.
5. LPAs observed that Licensee did not have a facility roster.
6. LPAs observed that a child's file is missing.

There were Technical Violations noted during today’s inspection. See LIC 9012 for the Technical Violations listed. 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.
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 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 encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. This report shall remain on file for 3 years. A Notice of Site visit was given at time of inspection and requested Licensee to post the Notice in a unobstructed, viewable area for 30 days. Exit interview conducted with Licensee INSERT. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell ChenTELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5