015700018-8-30-2021-52-CC-EWOS-C6DN4B-20210830100739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700018
Report Date: 08/30/2021
Date Signed: 08/30/2021 10:07:45 AM

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:	ZHOU, YIRU & LU, HE		FACILITY NUMBER:	015700018
ADMINISTRATOR:	LU, HE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 317-1188
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS: 8	DATE:	08/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Yiru Zhou & He Lu		TIME COMPLETED:	10:20 AM

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 August 30, 2021 at 08:30 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Required Inspection and met with licensee's, Yiru Zhou & He Lu. There were eight (8) children present during the inspection, four (4) infants and four (4) preschoolers . LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. LPA toured the home to conduct a health and safety inspection. The facility plans to operate between the hours of 8:30 AM-6:00 PM, Monday -Friday On-limit-areas are the: Living and dining room, bathroom to the left of hallway, and backyard Off-limit-areas are the: Kitchen, attached garage, all bedrooms, laundry room, nook room This home consist of 2 bedrooms, 2 baths, living and dining room, kitchen, nook area, attached garage, backyard, and laundry room ,which is neat and clean with heating and ventilation for safety and comfort. The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be a section of the dining room, away from other children in care. The outdoor play area is the fully fenced backyard. There's a hot tub that is located in the back right hand corner of the backyard that is fully covered and latched to prevent access to children. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools present in the on-limit areas during today's inspection. See 809-Continuation

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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: ZHOU, YIRU & LU, HE	FACILITY NUMBER: 015700018
	VISIT DATE: 08/30/2021

NARRATIVE

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The home has a fully charged 2A10BC fire extinguisher, working combination smoke/carbon monoxide detector, first aid kit and telephone. Per licensee, there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. Licensee's CPR and First Aid certificate is current and expires 06/2023. All required forms are posted and visible for public review.

At 9:00 AM LPA requested and reviewed the files of four (4) children in care. All files contained Identification and Emergency Information, Parent's Rights, and Medical Consent forms. The facility roster was reviewed, and copies was obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 03/12/2021. The licensee was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

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 her responsibility as mandated reporter.

LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

See Continuation

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHOU, YIRU & LU, HE	FACILITY NUMBER: 015700018
	VISIT DATE: 08/30/2021

NARRATIVE

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CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

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 followed by a written report within seven days.

Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. Per licensee, no IMS is being provided at this time. The licensee was reminded that when any changes to the IMS plan is made, an updated 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.”

There are no deficiencies cited. This report shall remain on file for 3 years. Exit interview was conducted with the licensee. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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