013422269-11-10-2021-52-CC-KPHN-C8MQG4-20211110110855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422269
Report Date: 11/10/2021
Date Signed: 11/10/2021 11:09:01 AM

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:	LI, WEI MING		FACILITY NUMBER:	013422269
ADMINISTRATOR:	LI, WEI MING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 407-2878
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	14	CENSUS: 8	DATE:	11/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Li, Wei Ming		TIME COMPLETED:	11:20 AM

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 11/10/2021 approximately at 8:40AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Li, Wei Ming. Present for this inspection was six toddlers and two infants. Also residing in the home is the licensee's fingerprinted husband, Xiangming Wu along with their fingerprinted and associated helper, Suxing Mei. Per licensee, she does not have any children of their own. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:30am to 6:30pm. ON LIMITS: playroom (family room)#1, playroom (near the kitchen) #2, and bedroom #1 (for napping infants). LPA reminded licensee that blankets and any other materials should not be inside the cribs. OFF LIMITS: kitchen, front yard and back yard, and garage, bedroom #2, bedroom #3, and bedroom #4, and all bathrooms per licensee children are all wearing diapers. Off limit areas are inaccessible by closed and/or locked doors, gate, and full visual supervision. The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. A child safety gates are required at OFF-LIMITED areas licensee is using a gate to keep children in the play rooms (family room area). 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. A fully charged 2A40BC fire extinguisher, working carbon monoxide and smoke detector has met State standards. The home has a fireplace but is blocked off by a secure screen. Per licensee, there are no firearms or pets or any bodies of water in the home. The licensee conducts and documents fire drill log indicates a drill was conducted 10/18/21. All required licensing documents are posted and visible for public review. At 10:30am, eight children files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee has proof of the required immunizations. The licensee has required mandated reporter training that is completed as of 11/06/2021. SEE LIC 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, WEI MING	FACILITY NUMBER: 013422269
	VISIT DATE: 11/10/2021

NARRATIVE

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CPR and First Aid training is updated as last completed was on 12/01/2021 for both licensee and her helper; Licensee advised LPA that she is in the process of scheduling for a class.Also LPA also advised licensee to assist her helper to complete required mandated reporter training every two years as she does not speak English. Licensee was able to show a signed and written declaration of denying the flu shot for her helper. LPA also advised licensee to email/text proof of sleep log and LIC 9227, and to immediately start using sleep log as of today 11/10/2021.

Exit interview conducted. Appeal rights and site visit was given to licensee to post for 30 days.

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

Facility Representative was reminded that California Law requires licensed Child Care Centers 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Facility Representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC809 (FAS) - (06/04)

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