015700121-7-30-2020-52-CC-RRED-BS228B-20200730170753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700121
Report Date: 07/30/2020
Date Signed: 07/30/2020 05:08:40 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:	HUANG, QING		FACILITY NUMBER:	015700121
ADMINISTRATOR:	HUANG, QING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 876-7513
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS:	DATE:	07/30/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Qing Huang		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	Due to the COVID-19 Pandemic, this pre-licensing inspection was conducted via tele-visit through FaceTime. Licensing Program Analysts, (LPA), Renee Reed met with applicant Qing Huang on 7/30/2020 at approximately 10:00 AM for an ANNOUNCED PRE-LICENSING INSPECTION via FaceTime. Present during this tele-inspection was applicant, applicants friend Tina Zhu via FaceTime to assist with language and applicants 5 year old daughter. . LPA, and applicant toured the home to conduct a Health and Safety Inspection. The facility currently plans to operate 7:00 AM to 6:00 PM., Monday through Friday. The home is neat and clean with heating and ventilation for safety and comfort. Description of Home: The residence is a two story; which consist of 4 bedrooms, 2.5 bathrooms. As you enter, there is a gate at front with a courtyard leading to front door. Living room with fireplace converted to child care room, dining/family room combo converted to child care room, kitchen and attached garage. Off Limit Areas: 1st floor kitchen area, entire upstairs level, and garage. The off-limit areas was inaccessible by child safety gates, closed and/or locked doors and visual supervision. On Limit Areas: 1st floor area on limits to children in care, which consist of living room, family/dining room area that have been converted to a playroom a 1/12 bathroom to the left side of home entering, as well as the backyard. Isolation area: family/dining room area converted to childcare room. 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: 07/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

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: HUANG, QING	FACILITY NUMBER: 015700121
	VISIT DATE: 07/30/2020

NARRATIVE

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The stairway has child safety gating at the base of the stairs. There is a fireplace which is covered by a piano to prevent access by children in care. There are multiple smoke detectors and a carbon monoxide detector present. The facility has a fully charged 3A40BC fire extinguisher. Fire Clearance was granted by Dublin Fire Prevention Services on 7-02-2020. There are age appropriate furnishings, toys and equipment in the child care rooms. The bathroom has working toilet and faucet in new condition. Per applicant, there are no firearms located or stored on the premises.

The facility has a fully fenced back yard area. There are no pools, hot tubs or other accessible bodies of water. There are age appropriate toys and equipment in the backyard. Hazardous items/cleaning supplies are stored inaccessible to children in care. All electrical outlets are safety outlets. Copy of Mortgage statement shows proof of control of property was reviewed.

The applicant’s Health and Safety training is completed (lead exposure included), CPR and First Aid certificate is current and expires 03-02-2021. The applicant completed and received a certificate in mandated reporter training on 04-02-2020. The applicant is following the immunization laws which pertains to all day care providers.

Applicant 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.

LPA, Reed reminded the applicant of the following; Mandated Reporter training is to be renewed every two years; CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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: 07/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

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: HUANG, QING	FACILITY NUMBER: 015700121
	VISIT DATE: 07/30/2020

NARRATIVE

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LPA Reed provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

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

This home is recommended for Licensure on 07/30/2020. A copy of this report was issued to applicant by email and is to remain in the facility records for a period of three years.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

LIC809 (FAS) - (06/04)

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