013422693-6-3-2021-02-CC-CCON-C3MQ5U-20210603115231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422693
Report Date: 06/03/2021
Date Signed: 06/03/2021 11:52:56 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	FU, HANPING		FACILITY NUMBER:	013422693
ADMINISTRATOR:	FU, HANPING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 328-0332
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	14	CENSUS: 0	DATE:	06/03/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Hanping Fu		TIME COMPLETED:	11:00 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 June 3, 2021, Licensing Program Analyst (LPA), Caroline Colson met with Hanping Fu an her adult son, (ZhiJun) Brendon Li and her husband, Lifu Li for a virtual case management inspection at 10:00 AM. Brendon assisted with language interpretation. All adults living and working in the home have criminal record clearances. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 8:00 AM to 5:30 PM on Monday - Friday. The home is a one story house. The home consists of three bedrooms, a living room, two bathrooms, front yard, fenced back yard and garage. The fenced back yard is being used as the outdoor play space. All bedrooms, kitchen and second bathroom are the off-limit areas. There is 2A10BC fire extinguisher, working carbon monoxide detector and a working smoke detector. Per Mrs. Fu states that there are no firearms in the home. There are toys available for the children. Mrs. Fu requested a waiver for her, her husband, and her adult son because their CPR and First Aid certificates expired. Mrs. Fu has screened wall heaters in the living room and hallway. The isolation area will be an area in the living room. All required documents are posted in the home. There are no pets. Her annual fees are current. Licensee submitted a COVID-19 Self-Assessment Guide. LPA reviewed responses with applicant and provided technical assistance including postings. Please See LIC 809 C for additional information

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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: FU, HANPING	FACILITY NUMBER: 013422693
	VISIT DATE: 06/03/2021

NARRATIVE

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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.

· 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

· Licensees may register to receive child care updates: www.myccl.ca.gov

There were no deficiencies cited today.

The license to return back to ACTIVE status and will be effective on June 3, 2021.

An exit interview was conducted. Appeal rights were discussed. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC809 (FAS) - (06/04)

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