015700167-9-21-2020-52-CC-RRED-BTNP57-20200921110018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700167
Report Date: 09/21/2020
Date Signed: 09/21/2020 11:00:48 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:	JIANG, YAN HONG		FACILITY NUMBER:	015700167
ADMINISTRATOR:	JIAN, YAN HONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 363-2381
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS: 0	DATE:	09/21/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Yan Hong Jiang		TIME COMPLETED:	10:45 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	DUE TO THE COVED-19 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS CASE MANAGEMENT, CHANGE OF LOCATION VISIT WAS DONE VIA TELE-VISIT THROUGH FACETIME. Licensing Program Analyst, (LPA) Renee Reed conducted an announced case management tele- inspection for a Change of Location, on Monday, 9/21/2020 at approximately 9:30 AM. Tele-Inspection (FaceTime) conducted with and toured the residence with licensee, Yan Hong Jiang. No children were in care. Licensee's hours of operation will be Monday thru Friday, 8:00 AM to 6:00 PM This residence was toured for a Health and Safety Inspection. 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, living room to the right of home converted to children's play room, kitchen, dining room, family room converted to childcare room and a attached garage. Off Limit Areas:: Entire Upstairs Level, kitchen and garage. On Limit Areas: living room, dining room, family room, bathroom, and backyard. Isolation Area: Entry Way Area of Home The stairway has child safety gating at the base of the stairs. There is a fireplace which is covered by a storage bin to prevent access by children in care. There are multiple combo smoke detectors/carbon monoxide detectors present. The facility has a fully charged 2A10BC fire extinguisher. Fire Clearance was granted by Dublin Fire Prevention Services on 09/11/2020. There are age appropriate furnishings, toys and equipment in the day care room. The bathroom has working toilet and faucet in new condition. 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: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

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: JIANG, YAN HONG	FACILITY NUMBER: 015700167
	VISIT DATE: 09/21/2020

NARRATIVE

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Per licensee, there is a firearm and ammunition located and stored separately in safes on the premises. The facility has a fully fenced back yard area. There are no pools, hot tubs or other accessible bodies of water. Hazardous items/cleaning supplies are stored inaccessible to children in care. All electrical outlets are safety outlets. Licensee has postings up regarding Covid-19.

LPA reminded the licensee 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 Report.

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 the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

This facility is approved for the change of location. A copy of this report was issued to licensee 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: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

LIC809 (FAS) - (06/04)

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