073408728-9-9-2021-02-CC-MSUN-C6PPFR-20210909111709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408728
Report Date: 09/09/2021
Date Signed: 09/09/2021 11:17:17 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	TANG, QIQI		FACILITY NUMBER:	073408728
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	09/09/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Qiqi Tang		TIME COMPLETED:	11:20 AM

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On 9/9/21 at 9:40 AM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Change of Capacity Inspection at Qiqi Tang home and met with Licensee, Qiqi who has applied for a Large Family Child Care Home with a capacity of 14 children. The home was toured to conduct a Health and Safety Inspection. The Child Care home operates Monday-Friday from 8:30am-6pm. Present during today's inspection was Licensee, assistant and 5 children ages 2-4. Living in the home Licensee and adult male, who fingerprints are still pending.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

INDOOR SPACE: At 10:00 AM LPA toured the indoor space of the home. The home consists of living room, kitchen, attached garage, 4 bedrooms and 2 bathrooms. The home is in compliance with Title 22 Regulations at this time.

IN-USE AREAS: Living room, kitchen, bathroom 1, bedroom 3 and backyard

OFF-LIMIT AREAS: Bedroom 1, Bedroom 2 , Bedroom 4, bathroom 2 and garage. Licensee is reminded to child proof doorknobs on all off-limit doors in the home.

OUTDOOR SPACE: AT 9:40 AM LPA toured the outdoor area (play yard) and observed it was fenced. LPA observed a shed located in the outdoor area locked and bedroom 4 which is locked. There is no AC unit in the outdoor area. LPA observed a station where children wash their hands and LPA discussed with applicant that there needs to be 100% supervision when children are playing with water.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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: TANG, QIQI	FACILITY NUMBER: 073408728
	VISIT DATE: 09/09/2021

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LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches in kitchen. LPA observed fire/disaster drills documented and required postings. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are 2 cats in the home. Licensee stated that there are no arms and ammunition stored in the home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a 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

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The following improvements to be completed prior to licensure of a large family childcare home.

1. Michael Le fingerprint clearance

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Qiqi Tang.
END OF REPORT

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle Sutton	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

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