013423633-5-13-2021-02-CC-ASIH-C2YQRR-20210513122422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423633
Report Date: 05/13/2021
Date Signed: 05/13/2021 12:24:58 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	LIU, GE		FACILITY NUMBER:	013423633
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/13/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Ge Liu		TIME COMPLETED:	12:45 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 05/13/2021 at 10:45 AM Licensing Program Analyst(LPA), Arminder Singh conducted an announced Pre-licensing Inspection. LPA met with applicant, Ge Liu. There was no one else at the home during the inspection. Applicant resides by himself in the home. Applicant applied for a Small Family Child Care Home with capacity for 8 children. Days and hours of operation will be Monday through Friday from 7:30 AM - 5:30 PM. Applicant has current Pediatric cardiopulmonary resuscitation (CPR) and First Aid which expires on 01/19/2023. Applicant is renting this property. Applicant has a working telephone in the home.(415-987-3350) At 11:00 AM: LPA toured the indoor space of the home with the Applicant. The home is a two story home which has two separate units. The Applicant resides in the downstairs part of the home which is Unit#B. The entrance to the applicants home is through the right side of the home near the side driveway. As you enter the front door one has to go down few steps to enter the home. The home consists of a living room/play area, three bedrooms, two bathrooms, kitchen, and a backyard. IN USE AREAS: Entire home is on limits, which consists of the living room/play area, bedroom#1/classroom, bedroom#2/play area, bedroom#3/music room. The bathroom #1 located in hallway is on limits. The bathroom #2 which is located in the bedroom#2 is also on limits. The backyard is on limits where the play ground is located, which is properly fenced off and has padded surface. OFF LIMIT AREAS: The side driveway is off limits for the children and the area of the backyard which is not fenced off for the play ground area. CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LIU, GE	FACILITY NUMBER: 013423633
	VISIT DATE: 05/13/2021

NARRATIVE

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The home is sanitary, safe and orderly, with central heating and ventilation for safety and comfort. There is a no fireplace in the home. LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors, fully stocked first aid kit, and applicant has all of the required postings, including the COVID-19 postings. The applicant was reminded to ensure that parents have access to the information. . Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets which are locked or out of reach of children. LPA reminded Applicants that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Applicants states there are no pets in the home. Applicant states there are no firearms and ammunition stored in the home.

At 11:30 AM Outdoor Space: Back Yard is fully fenced. Backyard is ON LIMITS only the area that has brown wooden fence for playground area. LPA reminded that 100% visual supervision is required when children are playing outside.

Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be practiced once every six months and documented.

LPA discussed Individual Medical Services (IMS) policy. Applicant does not plan on providing IMS at this time. 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.

CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LIU, GE	FACILITY NUMBER: 013423633
	VISIT DATE: 05/13/2021

NARRATIVE

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LPA reminded Applicant of the applicable $100 civil penalty per person per day, a minimum of $100.00 to a maximum of $3000.00 per person for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children.

LPA discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with Applicants. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Applicant has Safe Sleep Regulation Pamphlet and Lead Poisoning Flyer.

At 12:30 PM Exit interview was conducted with Applicant and LPA.

This home is recommended for licensing. LPA reminded the applicant that compliance with all Title 22 regulations and applicable Health and Safety regulations, must be maintained at all times.

Applicant signed the report acknowledging receipts of documents.

END OF REPORT

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC809 (FAS) - (06/04)

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