013421741-7-19-2021-52-CC-BPLY-C53VX6-20210719164902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421741
Report Date: 07/19/2021
Date Signed: 07/19/2021 04:49:07 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:	LIN, YANGJIN		FACILITY NUMBER:	013421741
ADMINISTRATOR:	LIN, YANGJIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 308-6706
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	14	CENSUS: 11	DATE:	07/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Yangjin Lin		TIME COMPLETED:	05:00 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 7/19/21 at 3:50pm, Licensing Program Analyst Briana Plumboy, met with licensee Yangjin Lin for an UNANNOUNCED REQUIRED 1 YEAR ANNUAL INSPECTION. Present for this visit was 1 infant, 10 preschool age children, licensee's adult daughter Jinglin Feng, and licensee's fingerprint clear and associated husband Jiancheng Feng. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am until 6:30pm. The home is single story. The home appears to be neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the 2 bedrooms, the master bedroom and master bathroom, the living room, the hallway bathroom, and the kitchen. The OFF LIMIT AREAS are the garage, and shed located in the backyard which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the master bedroom. There are child safety gates and child safety locks located throughout the facility. The BACKYARD play area is fenced. There are learning materials and 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 during the inspection there are no toxins or hazardous items accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and her husband Jiancheng Feng's CPR and First Aid certificates are current and expire 7/17/21. The licensee and her husband are in compliance with the immunization law. The home has centralized heating and there are no fireplaces in the home. 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 6/8/21. 6 children's files were reviewed and facility roster reviewed and copy obtained. 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 Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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 2

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: LIN, YANGJIN	FACILITY NUMBER: 013421741
	VISIT DATE: 07/19/2021

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

NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

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

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. This entire report was read to licensee by LPA Plumboy. Appeal rights provided and discussed. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2