013422682-7-23-2021-02-CC-ASIH-C57SV7-20210723141216

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422682
Report Date: 07/23/2021
Date Signed: 07/23/2021 02:12:25 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:	SHI, WENYING		FACILITY NUMBER:	013422682
ADMINISTRATOR:	SHI, WENYING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 860-8556
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	14	CENSUS: 5	DATE:	07/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Wenying Shi		TIME COMPLETED:	02:30 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 07/23/2021 at 12:30 PM Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Wenying Shi for an unannounced required 1 year inspection and explained the purpose of today's inspection. During the inspection the Licensee was present with her Assistant, who is fingerprint cleared. In today's inspection there are four infants and one preschooler preschoolers present. The children were napping in the bedroom while being supervised by the assistant. Days and hours of operation are Mon - Fri, 08:00 AM to 5:30 PM. At 01:15 PM the home was toured to conduct a health and safety inspection. The home is a one story home, consists of a kitchen, living room, one bedroom, one bathroom, and a backyard that has a laundry room (locked). The ON LIMIT AREAS are the living room, kitchen, bedroom, bathroom, and the outside yard which is located on rear of the home. The entrance to the yard is through the side gate. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, and carbon monoxide detector. There is centralized heating that is working and in good repair. Licensee states there are no firearms in the home. Licensee does have a pet dog who does not come around the children in the facility. The bedroom is the isolation room if needed. Licensee understands that while child is in isolation room there should be 100% visual supervision at all times. Licensee does have a fully stocked first aid kid. At 01:50 PM five (5) child's records (C1-C5) were reviewed by the LPA and the Licensee. Files are complete. Licensee and assistant have current Pediatric CPR and First Aid certificates and expire on 02/01/2022. Licensee and Assistant have current Mandated reporter training and was completed on 07/22/2021. Licensee conducts fire/earthquake drills every month. Last one was conducted on 07/16/2021. Please see LIC 809 C for additional information

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SHI, WENYING	FACILITY NUMBER: 013422682
	VISIT DATE: 07/23/2021

NARRATIVE

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This facility is not providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual.

REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

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.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.
"Mandated Reporter" training for CA Child Care Providers that all staff are required to complete as of January 1, 2018. [Starting May 2019, both General Training followed by Child Care Providers Training is required to be taken]. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

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SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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: SHI, WENYING	FACILITY NUMBER: 013422682
	VISIT DATE: 07/23/2021

NARRATIVE

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· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

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

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

In the areas that were evaluated, no regulatory violations were observed.

At 02:15 PM Exit Interview was conducted, where this report was reviewed and discussed with Licensee. Report was signed by the Licensee confirming receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

END OF REPORT

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC809 (FAS) - (06/04)

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