013421675-4-12-2024-02-CC-JMCN-D49TNX-20240412145328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421675
Report Date: 04/12/2024
Date Signed: 04/12/2024 02:53:38 PM

Document Has Been Signed on 04/12/2024 02:53 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	WAN, SONIA		FACILITY NUMBER:	013421675
ADMINISTRATOR:	WAN, SONIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 388-7901
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94602
CAPACITY:	14	CENSUS: 5	DATE:	04/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Sonia Wan		TIME COMPLETED:	03:00 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 April 12, 2024 at 10:45am Licensing Program Analyst (LPA) Janai McClain met with Licensee Sonia Wan to conduct an unannounced annual inspection. Present during today's inspection were the Licensee, her fingerprint cleared assistant Yuequan Yu, two preschoolers, and three infants. The licensee lives in the home with one small dog. The operating days and times are Monday - Friday 7:30am-6:00pm. The home was toured for a health and safety inspection. The home is a one story family home consisting of three bedrooms, two bathrooms, kitchen, living room, and fully fenced in backyard. On Limit Areas - The second bedroom on the right, living room, the bathroom in the hallway, and the fully fenced backyard. Off Limit Areas - The first bedroom on the right, the bedroom at the end of the hallway, the bathroom in the third bedroom, the deck, and the kitchen which will be used as a walk through to the backyard. Off limit areas will be made inaccessible through gates, locked/closed doors, and visual supervision. Isolation Area - is the chair in the living room. The home has a fully charged 3A10BC fire extinguisher, a working combination smoke and carbon monoxide detector in the hallway, and a working telephone. The Licensee stated she has Liability Insurance. The Mandated Reporter Certificate was not available for the licensee or her assistant. The Licensee has a current CPR and First Aid certificate which expires June 2025. The CPR and First Aid certificate was not available for assistant Yuequan Yu. The home has heating and ventilation for the safety and comfort of children in care. The Licensee has ample age-appropriate toys and learning materials in the home and in the backyard. Licensee is reminded to make sure toxins, medicines, and hazardous items are inaccessible to children. There were no bodies of water present on the premises. Per the Licensee there are no firearms in the home. *******Report Continues on LIC 809-C******

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WAN, SONIA	FACILITY NUMBER: 013421675
	VISIT DATE: 04/12/2024

NARRATIVE

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The last fire drill was completed on 1/5/2024.

LPA reviewed five files and found that the licensee was not logging in each 15 minute check during naps, which is a Type B violation.

LPA provided the Licensee with the Infant Safe Sleep Regulations and a copy of the "Individualized Safe Sleep Plan" (LIC 9227) was provided and reviewed.

Incidental Medical Services (IMS) policy was discussed. The Licensee is currently not providing IMS to the children in care. For IMS information see PIN 22-02. When any IMS is 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 reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed on Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 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.

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 **********************************Report Continues on LIC809-C********************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WAN, SONIA	FACILITY NUMBER: 013421675
	VISIT DATE: 04/12/2024

NARRATIVE

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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.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There were three Type B deficiencies issued during today's visit.

Exit interview conducted and report was reviewed with Licensee Sonia Wan.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/12/2024 02:53 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WAN, SONIA	FACILITY NUMBER: 013421675
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as there was no immunization record for assistant Yuequan Yu, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2024
	Plan of Correction
1 2 3 4	Licensee will email LPA a copy of assistant Yuequan Yu's immunization record by 5/13/2024.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the CPR and First Aid certificate for assistant Yuequan Yu was not available which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2024
	Plan of Correction
1 2 3 4	Licensee shall email LPA a copy of the CPR/first aid certificate or proof of registration by 5/13/2024.

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: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/12/2024 02:53 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WAN, SONIA	FACILITY NUMBER: 013421675
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Date, Infant’s name, Time of each 15-minute check, Labored breathing and Signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and Infants up to 12 month of age who are sleeping in a position other than on their back. Based on observation, the licensee did not comply with the section cited above in 3 out of 3 infants which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2024
	Plan of Correction
1 2 3 4	Licensee will complete the sleep log for infants in care for at least 5 days in a row and email a copy to LPA by 05/13/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

LIC809 (FAS) - (06/04)

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