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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422775
Report Date: 05/14/2019
Date Signed: 05/14/2019 10:30:52 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 JIE & WANG, LI QINGFACILITY NUMBER:
013422775
ADMINISTRATOR:WEI JIE LI & LI QING WANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 709-1181
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 10DATE:
05/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Li Qing WangTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Julia Placencia arrived at 8:35am for an unannounced Annual/Random Inspection, and met with Licensee Li Qing "Lily" Wang. Present for this inspection were 4 infants, 6 preschool age children, and the licensee's fingerprint cleared helper Guizhi Wu. Also residing in the home are the licensee's fingerprint cleared spouse and 10 year old son. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am to 6:00pm.

ON LIMITS: Living room, family room, downstairs bathroom, backyard, front yard.
OFF LIMITS: Kitchen, 2nd floor, garage, both side yards. Off limit areas are inaccessible by closed and/or locked doors and visual supervision.

The home is two story, which is neat and clean, with heating and ventilation for safety and comfort. The stairway had a child safety gate in place. The outdoor play areas are fenced, and free from defects and dangerous conditions. In the backyard there is a small double trampoline which is enclosed with safety netting. Per licensee, there is always supervision when children are playing on the trampolines. Both side yards are gated to prevent access by children. The front yard has a fenced-in play area with a wooden play structure, which is anchored to the ground and cushioned below. 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. There is a 2A10BC fire extinguisher, working carbon monoxide and smoke detectors, telephone, and first aid kit. The fireplace is boarded shut. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 2/6/19. All required licensing documents are posted and visible for public review. At 9:20am, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current and expires 4/28/20, helper Guizhi's expires 10/6/20. Licensee has proof of the required immunizations.
***Continued on LIC809C...
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, WEI JIE & WANG, LI QING
FACILITY NUMBER: 013422775
VISIT DATE: 05/14/2019
NARRATIVE
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The following deficiencies were observed during today's inspection:
  • At 8:50am, LPA observed the fire extinguisher was not fully charged.

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.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle. The licensee was advised of the required mandated reporter training to be completed as of 1/1/18, at www.mandatedreporterca.com

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

This report shall remain on file for 3 years. A Notice of Site Visit was provided at time of inspection and must remain posted for 30 days.

Exit interview conducted with Li Qing Wang. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
Page: 2 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, WEI JIE & WANG, LI QING
FACILITY NUMBER: 013422775
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2019
Section Cited
CCR
102417(g)(1)
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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
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Licensee shall have fire extinguisher serviced, or purchase a new one, and submit proof to CCL by due date of 5/21/19.
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This requirement is not met as evidenced by:
Based on observation, the fire extinguisher is not fully charged in the green, which poses a potential health and safety risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
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