013423145-8-8-2019-52-CC-JPLA-BEUU2M-20190808151211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423145
Report Date: 08/08/2019
Date Signed: 08/08/2019 03:12:18 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:	SU, HANG		FACILITY NUMBER:	013423145
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	08/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Hang Su		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Julia Placencia arrived to the facility unannounced for an Annual/Random Inspection, and also to determine if the facility is ready for an INCREASE IN CAPACITY. LPA met with Licensee Hang Su. Present were three infants, which includes the licensee's 7 month old child, and her fingerprint cleared mother-in-law. Also residing in the home is licensee's fingerprint cleared spouse and father-in-law. 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 6:30pm.. ON LIMITS: Activity room, back patio, back left bedroom (for napping) with connecting bathroom. The isolation area will be the napping room or the activity room. OFF LIMITS: Remainder of home is off limits. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits. Per the fire clearance, day care activities are not permitted in the garage. The home is single story, and is neat and clean, with heating and ventilation for safety and comfort. The outdoor play area is the enclosed gated patio. There is also a fence surrounding the perimeter of the backyard. There are ample age appropriate toys that appear to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible. Fire extinguisher, carbon monoxide and smoke detectors meet State Fire Marshall Standards. The home does not have a fireplace. Per licensee, there is a firearm which is locked in the off limit middle bedroom, and the ammunition is stored separately. The licensee conducts and documents fire and disaster drills, and log indicates a drill was conducted 6/26/19. All required forms are posted and visible for public review. 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. ***Continued on LIC809C....

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: SU, HANG	FACILITY NUMBER: 013423145
	VISIT DATE: 08/08/2019

NARRATIVE

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The licensee's Pediatric CPR and First Aid certificate is current and expires 1/13/20. The licensee has proof of the required immunizations pertaining to child care providers, and mandated reporter training was completed 7/1/18. Safe sleep practices were discussed with licensee, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle.

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.

There were no deficiencies observed during today's inspection. This report shall remain on file for 3 years. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

The department received the approved fire clearance from the City of Fremont on 8/5/2019. Licensee has met all requirements for the Increase of Capacity. As of today's date, 08/8/2019, licensee may begin operating as a Large Family Day Care.

Exit interview conducted with Hang Su, and appeal rights provided.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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