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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421890
Report Date: 04/19/2022
Date Signed: 04/19/2022 03:59:06 PM


Document Has Been Signed on 04/19/2022 03:59 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:ZHU, CHANGFACILITY NUMBER:
013421890
ADMINISTRATOR:ZHU, CHANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 499-7768
CITY:ALAMEDASTATE: CAZIP CODE:
94502
CAPACITY:14CENSUS: 9DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Chang ZhuTIME COMPLETED:
04:00 PM
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On 04/19/2022 Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Chang Zhu for an unannounced random annual inspection. During inspection Licensee's fingerprint cleared Assistant was also present. LPA arrived when children were involved in various activities/napping. There are 9 children present today. Records of four children (C1-C4) were reviewed and are complete. The home was toured to conduct a health and safety inspection. The Licensee's hours of operation are Monday-Friday, 8:00AM-6:00PM. Licensee has a working telephone in the home.

LPA toured the indoor space of the home. The home is a single story home, with heating and ventilation for the safety and comfort of children in care. Home consists of 3 bedrooms, 2 bathrooms, living room, kitchen, dining room, playroom, backyard, and an attached garage.

IN USE AREAS:Dining area, covered patio(playroom), bedroom on the right side of the home (nap area), and both of the bathrooms.

OFF LIMIT AREAS: Living room, kitchen, garage, and the two bedrooms located on left side of home. All off limit areas are made inaccessible by gate, closed and/or locked doors and visual supervision.


The home is sanitary, safe and orderly, with central heating and ventilation for safety and comfort. LPA observed required Postings on the wall. There is a non-functional fireplace in the Living Room. LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors all over the home. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and out of reach of children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Licensee states there are no pets in the home. Licensee states there are no firearms and ammunition stored in the home.



SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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 3


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: 04/19/2022
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The Licensee's CPR and First Aid certificate is current and expires 01/2024. The licensee conducts and documents fire and earthquake drills at least twice a year. Last fire drill was conducted on October 2021. LPA reminded Licensee that the mandated reporter training certificates are to be renewed every two years.

Outdoor Space: Back Yard is fully fenced. Backyard is ON LIMITS. Play equipment are in good condition. LPA reminded that 100% visual supervision is required when children are playing outside.

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

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 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.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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: 04/19/2022
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Licensees was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensees 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.

There were no deficiencies in today's visit.

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

Exit interview was conducted and report was reviewed with the Licensee, Chang Zhu.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3