013421890-11-26-2019-02-CC-LDYN-BJAUU3-20191126145253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421890
Report Date: 11/26/2019
Date Signed: 11/26/2019 02:52:59 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZHU, CHANG		FACILITY NUMBER:	013421890
ADMINISTRATOR:	ZHU, CHANG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 499-7768
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94502
CAPACITY:	14	CENSUS: 4	DATE:	11/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Chang Zhu		TIME COMPLETED:	03:05 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 11/26/19 at 1:40pm, Licensing Program Analysts (LPAs) Loretta Dyson and Arminder Singh arrived at the home for an unannounced random inspection. LPAs met with the licensee. The licensee's fingerprint cleared father, 3 infants, 1 preschool age child, 2 teenage nieces and the licensee's child who is over 10 years old were also present. LPAs conducted a tour of the areas of the home that are used for the child care, with the licensee, to conduct a health and safety inspection. The home is a single story home, which is neat and clean with heating and ventilation for the safety and comfort of children in care. The on limit areas include the living room, dining area, family room, covered patio, bedroom on the right side of the home and both of the hallway bathrooms. All other areas are off limits to children and are made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area will be a section of the family room, away from other children in care, or the on limit bedroom when it is not nap time. The outdoor play area is fully fenced and free from defects or dangerous conditions. There are ample age appropriate toys that appear to be safe and in good condition. LPAs did not observe any bodies of water, hazardous items or toxins accessible today. The home has a fully charged 2A10BC fire extinguisher, smoke detector, carbon monoxide detector, working telephone and fully stocked first aid kit. The licensee has proof that she enrolled in the CPR/first aid training that will be on 1/12/20. The fireplace is blocked to prevent access by children, and there are no heaters accessible to children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills at least twice a year, and the log indicates that the last drills were done on 9/10/19. Children's files were reviewed. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. *******************************************************************************continued on 809C

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHU, CHANG	FACILITY NUMBER: 013421890
	VISIT DATE: 11/26/2019

NARRATIVE

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The licensee stated that there are no children enrolled at this time, who require medication while in 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. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensee provided proof that she completed the required mandated reporter training on 2/22/18. The licensee was reminded that the training needs to be renewed every 2 years, at www.mandatedreporterca.com.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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