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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422775
Report Date: 01/09/2023
Date Signed: 01/09/2023 03:52:31 PM


Document Has Been Signed on 01/09/2023 03:52 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:WANG, LIQINGFACILITY NUMBER:
013422775
ADMINISTRATOR:WANG, LIQINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 709-1181
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 9DATE:
01/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Liqing (Lily) WangTIME COMPLETED:
03:58 PM
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On January 9, 2023 at approximately 12:35pm Licensing Program Analyst (LPA) Haderer met with the licensee Liqing Wang for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, her fingerprint cleared assistant and mother, and 9 children in care (1 infant and 8 preschoolers). Hours of operation remain the same at 9:00am to 5:30pm.

The facility is a two-story home with 4 bedrooms, 2 ½ bathrooms, a kitchen, dining room, living room, family room and an attached 2-car garage, front, back and side yards. There is an unused fireplace in the living room completed covered and sealed off, there is an additional screened fireplace in the family room. The home has an attached one bedroom mother-in-law apartment, tenants are not present during day care activities. The home on and off limits will remain as originally licensed.

ON LIMIT AREAS: Living room, dining room, family room , downstairs ½ bathroom near the small garage door, the front, southside and back yards. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. OFF LIMIT AREAS: The entire upstairs and bedrooms, the one room mother-in-law apartment and attached 2-car garage, north side yard. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.

There is a large play structure in the front yard that is free from hazards and has soft materials underneath. The front yard has a fence surrounding the area, children are supervised at all times while playing. Licensee has ample age-appropriate toys and learning materials (Montessori style) inside the home. There is a large fish tank in the living room with goldfish and filled only halfway. The children can look at the fish but is it out of reach to them. Per licensee there are no fire arms in the home. If a child becomes ill during the day, the child is kept isolated away from other children in care until their parents can come pick them up.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023
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 5


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: WANG, LIQING
FACILITY NUMBER: 013422775
VISIT DATE: 01/09/2023
NARRATIVE
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The home has a fully charged 2A10BC fire extinguisher in the entryway, smoke detectors and carbon monoxide detector (all tested and working) and a working telephone. Disaster drills are conducted at least once every 6 months, the last drill was done on 9/16/2022.

LPA reviewed facility files including records for licensee and assistants and the Children’s files. The licensee’s Health and Safety training is completed. Both the licensee and helper have current CPR and First Aid certificates, both expire 8/14/2023. Mandated Reporter training was completed 3/18/2020 (licensee), helper was completed 9-19-2021. Licensee is out of compliance on this and will renew the training see LIC809D for deficiency. Licensee was reminded that CPR/1st Aide is to be renewed every two years. The licensee and helper are in compliance with the immunization laws which pertains to day care providers. Licensee’s mother has moved into the main home and is fingerprint cleared and associated to the facility but does not have proof of TB test. See LIC809D for deficiency.

Children’s files were complete and well organized. One child’s file was missing the immunization records. See LIC809D for deficiency. Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

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 LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: WANG, LIQING
FACILITY NUMBER: 013422775
VISIT DATE: 01/09/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were three deficiencies issued today, see LIC809D for details:


- Licensee’s Mandated Reporter has expired
- Licensee’s mother has moved into the home and needs a negative TB test or a clear x-ray

- One child’s file was missing proof of immunization

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the licensee LiQing Wang.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/09/2023 03:52 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: WANG, LIQING
FACILITY NUMBER: 013422775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that licensee's Mandated Reporter certificate has expired which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2023
Plan of Correction
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Licensee will renew the certificate and provide new certificate copy as proof to LPA.
Type B
Section Cited
CCR
102416.2(a)(2)
Reporting Requirements
(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in that licensee's mother has moved into the main home, has fingerprint clearance and is associated to the facility but needs a TB test to confirm she is negative or has a clear lung x-ray which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will get her mother to complete a TB test or clear chest x-ray and will provide proof to LPA
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 01/09/2023 03:52 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: WANG, LIQING
FACILITY NUMBER: 013422775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the file for one child in care did not contain immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2023
Plan of Correction
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Licensee will get proof of immunization from the parents and provide proof to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5