013423312-12-18-2019-52-CC-BPLY-BJYS6B-20191218123536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423312
Report Date: 12/18/2019
Date Signed: 12/18/2019 12:35:42 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:	LEI, YUANYAN		FACILITY NUMBER:	013423312
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	12/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Yuanyan Lei		TIME COMPLETED:	01:00 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	On 12/18/19, Licensing Program Analyst Briana Plumboy met with licensee Yuanyan Lei for an UNANNOUNCED RANDOM INSPECTION AND INCREASE IN CAPACITY. Present for this visit was licensees fingerprint clear and associated husband Zhidong Guo (whom translated the inspection), fingerprint clear and associated assistant Ling Gun Wong, and 3 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am until 6:00pm. The licensee currently has valid day-care insurance. The home is single story. The home consists of 4 bedrooms, 1 master bedroom with bathroom, 1 hallway bathroom, dining room, living room, family room, kitchen, laundry room, and garage. The home is neat and clean with heating and ventilation for safety and comfort. On 12/16/19, a FIRE CLEARANCE was granted to the facility by the Union City Fire Department and states "The above facility has been approved with a fire clearance. All bedrooms, garage, and kitchen are off limits for daycare use/activity at all times." The OFF LIMIT AREAS are the laundry room, kitchen, garage, 4 bedrooms, and master bedroom/bathroom which will be inaccessible by closed and/or locked doors and visual supervision. There are child safety gates located at the entrance of the family room, entrance of the living room, and 2 entrances to the kitchen. The ON LIMIT AREAS are the living room, family room, dining room, and hallway bathroom. The ISOLATION AREA will be the living room. Outdoor play area will be located inside the fenced backyard. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present at the facility during todays inspection. All hazardous materials and toxins were observed to be out of the reach of children during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires 03/02/21. The licensee is aware when the mandated reporter training is available in Mandarin, she must complete the training and obtain a certificate. The licensee is in compliance with the immunization law. The fireplace is located inside the living room and is screened to prevent access by children. 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 08/26/19. A copy of the roster was reviewed and a copy was obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

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: LEI, YUANYAN	FACILITY NUMBER: 013423312
	VISIT DATE: 12/18/2019

NARRATIVE

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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 Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

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 reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

The fire clearance for the increase in capacity was received and approved on 12/16/19.
No deficiencies are being cited during today's inspection. This home is recommended for the capacity increase as of today's date. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

LIC809 (FAS) - (06/04)

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