013423330-7-14-2021-52-CC-RRED-C4WTGC-20210714144254

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423330
Report Date: 07/14/2021
Date Signed: 07/14/2021 02:43:04 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, SARA & WONG, ANTHONY		FACILITY NUMBER:	013423330
ADMINISTRATOR:	SARA LEI & ANTHONY WONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 399-8189
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS: 15	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Sara Lei & Anthony Wong		TIME COMPLETED:	03:00 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 7/14/2021 at approximately 11:24 AM Licensing Program Analyst (LPA) Renee’ Reed arrived for a UNANNOUNCED 1 Year Inspection. LPA met with Licensees Sara Lei and Anthony Wong. Present for this inspection are 3 infants and 12 pre-school age children in care (out of ratio).This facility currently operates on Monday to Friday from 7:30 AM - 5:30 PM. LPA conducted a health and safety inspection of the facility. The home is 2 story home consisting of 5 bedrooms, 5 bathrooms, kitchen, dining room, family room, laundry room, backyard area and garage. The ON LIMITS areas are first level: bedroom located on the left next to main entrance, bathroom located next to bedroom, kitchen/dining area, 2nd bedroom converted to playroom located next to family room and backyard area. The OFF LIMITS areas are second level: the 3 bedrooms and 3 bathrooms, laundry room, bathroom on first level in bedroom #2 and the garage, which during inspection was inaccessible by closed and/or locked doors and visual supervision The home has a fully charged 3A:40:BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and a pull down fire alarm. The ISOLATION AREA will be the 1st bedroom near main entrance. The BACKYARD play area is fenced. There are ample age appropriate toys that are safe and in good condition. It was observed that there are no toxins or hazardous items accessible. No pools, hot tubs or any bodies of water on premises. See-809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: LEI, SARA & WONG, ANTHONY	FACILITY NUMBER: 013423330
	VISIT DATE: 07/14/2021

NARRATIVE

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The licensees' CPR and First Aid certificate is current and expires on 10/12/2021. During inspection LPA observed all required documents are posted in prominent view for the public. LPA observed the licensees fire and disaster drill was posted and last conducted on 6/18/2021. Licensees received a certificate in Mandated Reporter Training on 5/24/2021 for Tony and 5/27/2021 for Sara.

The licensees are compliance with the immunization law. Per licensee, there are no children on prescription medications.

At 12:16 PM LPA reviewed 5 children files which are complete, facility roster reviewed and copy obtained. The licensee is out of ratio today. Safe sleep regulation information was discussed and LPA provided a copy of Individual Sleep Plan LIC 9227. No children in care are on any medications. Per Licensees no IMS services are being provided. 1:30 PM two part time children left.

Licensee is reminded CPR & First Aid to be renewed every 2 years and Mandated reporter every 2 years.
Licensee is also reminded any structural changes to be reported to Community Care Licensing.

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

There are deficiencies cited today. 102416.5 Staff Ratio Capacity

See 809-D
A copy of this report was given and shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Appeals Rights discussed a provided. Exit interview conducted.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: LEI, SARA & WONG, ANTHONY	FACILITY NUMBER: 013423330
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/14/2021 Section Cited	1 2 3 4 5 6 7	102416.5 (a)(f) Staff Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.(f)The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children. This requirement was not met by evidence by:
	8 9 10 11 12 13 14	Based on observation and physcial census LPA observed 3 infants and 12 pre-school age children. LIcensee is therefore out of ratio with 15 children in care and this poses an immediate health and safety risk.	8 9 10 11 12 13 14	LPA to revisit Licensee within 30 days to ensure licensee is in RATIO. 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.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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