015700152-9-1-2020-52-CC-JWIS-BT2W4S-20200901165802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700152
Report Date: 09/01/2020
Date Signed: 09/01/2020 04:58:33 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:	ZHENG, HUA		FACILITY NUMBER:	015700152
ADMINISTRATOR:	ZHENG, HUA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 449-6528
CITY:	NEWARK	STATE: CA	ZIP CODE:	94560
CAPACITY:	14	CENSUS: 0	DATE:	09/01/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant - Hua Zheng		TIME COMPLETED:	04:35 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 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS PRELICENSING VISIT WAS CONDUCTED VIA TELEVISIT.

On 9/1/2020 at 9:00am Licensing Program Analyst (LPA) Jonathan Williams met with Applicant Hua Zheng via video conferencing app "Zoom" for the purpose of conducting an announced prelicensing inspection for a change of location. Present during today's inspection was the Applicant and the Applicant’s fingerprint cleared and associated husband. The home was toured to conduct a health and safety inspection.

The facility is a two story home owned by the Applicant. The first floor consists of a bedroom (‘Bedroom for Daycare”), bathroom, half bathroom (“powder” room), living room (“Great Room for Daycare”), kitchen, backyard, and garage in two sections. The second floor consists of a loft, three bedrooms, three bathrooms, laundry room, and balcony. The home is neat and clean. All toxins, hazardous materials, and cleaning compounds were observed to be made inaccessible to children throughout the inspection. The home has central heating and does not have a fireplace or wall heater. Per Applicant, there are no firearms in the facility. Stairs leading to second floor were shown to be barricaded at 11:46am.

On-limit-areas: “Great Room for Daycare”, “Bedroom for Daycare”, first floor bathroom, “powder” room, “Children Play Area” in the backyard.
Off-limit areas: Entire second floor, kitchen, garage, area in backyard separated by fence from “Children Play Area”.
Isolation room: “Bedroom for Daycare”.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

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 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: ZHENG, HUA	FACILITY NUMBER: 015700152
	VISIT DATE: 09/01/2020

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
26
27
28
29
30
31
32

The backyard was toured at 10:25am. There is age appropriate equipment in the "Children Play Area" (on-limits area of the backyard) that appears to be safe and in good condition during this inspection. LPA observed that the on-limits "Children Play Area" is separated from the off-limits area of the backyard by a fence to prevent access by children to the off-limits area. LPA did not observe any bodies of water on the facility premises.

The home was observed at 10:40am to have fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detectors, and a working telephone. The Applicant’s Preventive Health and Safety training is completed, and Applicant produced EMS-certified certificate in CPR and First Aid training which LPA observed at 11:33am to expire on 12/2020. The Applicant produced proof of Mandated Reporter Training “Child Care Providers” which LPA observed at 11:35am to have been completed on 6/17/2020. Proof of control of property was submitted and reviewed by LPA. A fire clearance was granted by Newark Fire Department on June 30, 2020.

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. Applicant was reminded of the responsibility as a mandated reporter.

Applicant was reminded that California Law requires licensed 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the Applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Applicant was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

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: ZHENG, HUA	FACILITY NUMBER: 015700152
	VISIT DATE: 09/01/2020

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed at 11:45am. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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.

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

Due to the following missing items, licensure cannot be completed at this time. Applicant was advised that the following corrections must be made before a license can be issued:

1. Mandated reporter training certificate for “General” training must be submitted.

2. Facility sketches must be resubmitted (Floor and Yard). Off-limit areas must be clearly marked. Facility sketch of second floor must be submitted with off-limit areas clearly marked.

Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3