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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423450
Report Date: 02/07/2024
Date Signed: 02/07/2024 11:13:27 AM

Document Has Been Signed on 02/07/2024 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MA, SHAORONGFACILITY NUMBER:
013423450
ADMINISTRATOR:MA, SHAORONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 690-5366
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
02/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Daughter Ma,YanxiaTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Jyoti Saini arrived for an unannounced Annual Random Inspection at the facility. LPA disclosed the purpose of the inspection and was granted entry into the facility by the daughter. During this inspection, a helper and daughter licensed at the other location ( see attached LIC9102 technical violation) were supervising 11 preschoolers. Licensee Ma Shaorong and one more helper arrived during the inspection. Licensee's primary language is not English. The daughter helped translate during the inspection.The home is a single home with two bedrooms, including a master bedroom with master bathroom, hallway bathroom, living room, kitchen with dining area, garage, and back yard. The hours of operation are 8:00 am to 6:00 pm Monday -Friday. The facility has liability insurance through Accord Insurance.
ON-LIMIT AREAS are the living room, dining area, hallway bathroom, bedroom #2, and backyard.
OFF-LIMIT AREAS are the master bedroom, master bathroom, kitchen, and garage, made inaccessible to children by locked doors, safety gates, and visual supervision.

LPA observed the following: The Daycare Area is clean, orderly, and equipped with age-appropriate toys and equipment for children, indoors and outdoors. The home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or Fireplace in the Daycare area. There are child-size tables and chairs for snacks and activities. Each child has a separate cot and separate blankets. The blankets are washed weekly by the Parents. The outdoor play area is fenced and with rubber cushioning under the play structure. The Licensee states there are no guns or weapons in the home. Electrical outlets have child-protective covers, making them inaccessible to children. The applicant is reminded that NO walkers, exersaucers, jumpers, bouncers, or similar items are to be used for children in care and shall be made inaccessible.
The Licensee and helpers have current CPR and current Mandated reporter training certificates on the file.The Licensee conducted the last emergency drill on 12/01/2023, which is properly logged. The Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children's files. All the files are complete and up to date. All required postings are properly posted. A copy of the children's roster was available for review, and a copy was obtained.
See the next page
Wynn Norona
Jyoti Saini
DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MA, SHAORONG
FACILITY NUMBER: 013423450
VISIT DATE: 02/07/2024
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During Inspection, 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.

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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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.

No deficiency is cited today; however, one technical violation was given.



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

Exit interview conducted and report was reviewed with the licensee, Shaorong Ma.

SUPERVISOR'S NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC809 (FAS) - (06/04)
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