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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422897
Report Date: 10/18/2021
Date Signed: 10/18/2021 01:40:11 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:YUAN, ALICEFACILITY NUMBER:
013422897
ADMINISTRATOR:YUAN, ALICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 754-8253
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 11DATE:
10/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Alice Yuan- LicenseeTIME COMPLETED:
01:45 PM
NARRATIVE
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On 10/18/21 at 10:15am, Licensing Program Analyst Briana Plumboy met with licensee Alice Yuan for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was 3 infants and 8 preschool age children. During the inspection, licensee's fingerprint clear and associated husband Ronald Boivin arrived at 10:48am who is licensee's assistant. The home was toured to conduct a Health and Safety Inspection. The facility is currently open Monday through Friday from 8:30am until 6:00pm.

The home is a one story, single family home. The ON LIMITS areas are: the playroom, kitchen, dining room, classroom, and bathroom to master bedroom #2, and yard. The OFF LIMITS areas are: Study Room, Master bedroom #1, Master bedroom #2, bedroom #3, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the playroom. The BACKYARD play area is fenced. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The home utilizes the NEST system. The licensee's CPR and First Aid certificate is current and expires 08/21/2023. The licensee and assistant Ronald are in compliance with the immunization law. The licensee has a waiver for the mandated reporter training course until it is available in Mandarin, and licensee's assistant Ronald's mandated reporter training certificate expired 10/3/21. The fireplace is barricaded to prevent access by children, and located inside the living room. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 06/1/21. The licensee has day care insurance during today's inspection. All REQUIRED forms are posted and visible for public review.

Today the licensee is cited the following:
1) The licensee was out of ratio upon LPA Plumboy's arrival at 10:15am. The licensee was placed back in ratio once her husband/assistant arrived at 10:48am.
2) Poisons, detergents, cleaning compounds, medicines and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. In the bathroom, it was observed the cabinet drawers are not locked and there are cleaning supplies and objects which may pose an immediate risk to the health and safety of children. See 809-C AND 809-D for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: YUAN, ALICE
FACILITY NUMBER: 013422897
VISIT DATE: 10/18/2021
NARRATIVE
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3) Mandated reporter training for assistant is expired.
4) Use of off limit area
5) Conduct Inimical
6) If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times

Incidental Medical Services (IMS) policy was discussed. 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 was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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 reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Alice Yuan 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 Alice Yuan 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.

The attached Type A deficiencies are cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file.

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

See (4)809-Ds cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Alice Yuan.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: YUAN, ALICE
FACILITY NUMBER: 013422897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 3 out of 5 cabinets located in the bathroom had broken child safety locks and in the cabinets were cleaning supplies and hazardous items which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2021
Plan of Correction
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On or before 10/19/21, licensee stated she will fix the 3 broken child safety locks on the bathroom cabinets and send a video to LPA Plumboy showing the cabinets lock.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above by being alone with 3 infants and 8 preschool age children upon LPA Plumboy's arrival at the facility at 10:15am. At 10:48am, licensee's husband arrived placing the facility back in ratio. The licensee being alone with 10 children places her out of ratio which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2021
Plan of Correction
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Cleared during inspection
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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: YUAN, ALICE
FACILITY NUMBER: 013422897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2021

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's assistant did not comply with the section cited above due to his mandated reporter training certificate expiring 10/3/21 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/18/2021
Plan of Correction
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 Training can be found at mandatedreporterca.com.
The licensee's assistant must complete the mandated reporter training by 11/18/21 and submit to LPA by email or mail.
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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: YUAN, ALICE
FACILITY NUMBER: 013422897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. At 12:30pm, an infant was observed inside a room in an off limits area which poses an immediate health, safety or personal rights risk to persons in care. The door to the room was closed.
POC Due Date: 10/19/2021
Plan of Correction
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LPA Plumboy and Licensee discussed the importance of children having care in "on limit" areas only with the doors open. Licensee will review the safe sleep regulations found in Title 22, Division 12, Chapter 1, Article 6, Section 102425. Licensee will submit a summary of regualtions she learned.
Type A
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building 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 is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. At 12:30pm, an infant was observed inside a room which is not licensed to be used by children in care. This area is an off limits area. By childred in care using off limits areas, it poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2021
Plan of Correction
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LPA Plumboy and Licensee discussed the importance of children having care in "on limit" areas only. On or before 10/19/21, licensee stated she will watch the video "Locks and Inaccessibily" on the ccld.ca.gov website and submit a written summary to LPA Plumboy via email.
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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: YUAN, ALICE
FACILITY NUMBER: 013422897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.885(c)
Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility ot the people of the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview when LPA Plumboy entered licensee's home, licensee stated the children in the kitchen and living room where all children in care. The licensee did not comply with the section cited above. At 12:30pm, LPA Plumboy heard a cry and an infant was inside the first bedroom located on the right side of the hallway in an off limit area. By not telling the truth it poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2021
Plan of Correction
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On or before 10/19/21, licensee agreed to write a statement about being honest in all her dealings with the Department.
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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2021
LIC809 (FAS) - (06/04)
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