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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422269
Report Date: 09/20/2022
Date Signed: 09/20/2022 12:05:08 PM


Document Has Been Signed on 09/20/2022 12:05 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 STE 1102
OAKLAND, CA 94612



FACILITY NAME:LI, WEI MINGFACILITY NUMBER:
013422269
ADMINISTRATOR:LI, WEI MINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 407-2878
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:14CENSUS: 0DATE:
09/20/2022
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Wei Ming Li TIME COMPLETED:
12:20 PM
NARRATIVE
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On September 20, 2022 at 11:05AM, Licensing Program Analyst (LPA) Kelly Phan met with licensee Li for an announced collateral visit at a local Starbucks (5034 Mowry Ave, Fremont CA 94538). Present for the visit was just the licensee. Per licensee's request, she wants to meet at a local Starbucks to discuss findings due to the traumatic event at her facility.

A complaint was filed on 04/12/2022 that pertained to a questionable death. During the complaint investigation, Investigation Branch (IB) Investigator, Maria Barragan and LPAs discovered that an OFF-limit area was used for the alleged day care child and both licensee and her helper did not renew their CPR and First aid trainings after 12/01/2021. As a result, two (2) Type B citations were issued today. SEE LIC 809D. Plan of Corrections (POC) was developed with licensee to register and renew both CPR and First aid trainings from an emergency medical services authority (EMSA) approved course for her helper and herself to comply. Licensee was also advised to send an acknowledgement letter stating that the OFF limit area would not be in use until an inspection is conducted and approved by Licensing.

Exit interview conducted with licensee Li and copy of report, appeal rights, and notice of site visit were provided and must be posted for 30 days. Failure to comply with this posting requirement shall result in immediate civil penalty of $100.00.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
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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Document Has Been Signed on 09/20/2022 12:05 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: LI, WEI MING
FACILITY NUMBER: 013422269

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2022
Section Cited

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102416.3 Alternations to Existing Buildings or Grounds: (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement was not met as evidenced by:
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Based on observations and record review, licensee did not comply with the section cited above as licensee used an OFF-limit area for a sleeping daycare child and did not notify licensing of the proposed change, which poses a potential health, safety, or personal rights risk to persons in care
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Type B
09/20/2022
Section Cited

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102416 Personnel Requirements: (1) Health and Safety Code Section 1596.866 provides in part: (b) A licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or when children are off-site of the facility for facility activities. This requirement was not met as evidenced by:
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Based on record review and interviews by Investigation Branch (IB) investigator, licensee did not comply with the section cited above as licensee and her helper failed to renew their CPR and First aid training after 12/01/2021, which poses a potential health, safety, or personal rights risk to persons in care
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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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
LIC809 (FAS) - (06/04)
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