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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011883
Report Date: 05/14/2019
Date Signed: 05/14/2019 01:32:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WANG FAMILY CHILD CAREFACILITY NUMBER:
198011883
ADMINISTRATOR:LI HUA WANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 854-1092
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:14CENSUS: 6DATE:
05/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Li Hua WangTIME COMPLETED:
01:40 PM
NARRATIVE
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Random inspection conducted by Licensing Program Analyst, (LPA) Jennifer Hua. LPA Met with licensee, who guided the analyst on a tour of the facility. Upon arrival, LPA observed licensee was alone with 6 children, 4 of whom are under age 2 (infant) and 2 of whom are age 2. Licensee was out of ratio by 1 infant. Licensee called her assistant/spouse Wei Liu to return. Her spouse returned about 35 minutes later. The facility is a single story dwelling, with 3 bedrooms and 2 bathrooms. Per licensee, people live in the home are 3 adults and 0 children

Areas used by children were inspected as follows: Kitchen area, living room, dinning area, hall bathroom.
Per licensee, there are no weapons, firearms, swimming pool or spa on the premises. The backyard is adequately fenced.

There are age appropriate toys and equipment on the premises. The smoke/carbon monoxide detectors and fire extinguisher (2A 10BC) are in operable condition. Fire extinguisher was serviced on 5/27/18. LPA also observed a crib, play yard and napping mats for children.

Areas off limits include: 3 bedrooms, room next to kitchen and one bathroom. Per licensee children do not go outside.

Licensee is current in Pediatric CPR/First Aid. Certificate expires 1/12/2021.
-Child Care Roster, Disaster Plan, and Children's Records were reviewed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WANG FAMILY CHILD CARE
FACILITY NUMBER: 198011883
VISIT DATE: 05/14/2019
NARRATIVE
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Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, Johnny jumpers, exersaucers, bouncers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby, A Child Care Provider's Guide to Safe Sleep was provided to licensee. Affidavit for Liability insurance form in children's files. Licensee has completed the Mandated Reporter Training dated 12/3/17 on certificate. 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) 514-0388 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
· Dog(s) and or pets should be isolated from children in care. No pets
· It is recommended that a First Aid kit be available on premises.
Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.
Deficiencies cited on attached 809D.
Upon receipt of this report documenting a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.
Exit interview was conducted with licensee. Appeal Rights procedures explained.
Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WANG FAMILY CHILD CARE
FACILITY NUMBER: 198011883
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2019
Section Cited
CCR
102417(g)(8)
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Operation of a Family Child Care Home. The requirement is not met as evidenced by: Roster is not updated as requrired. This poses a potential risk to the health and safety of children in care.
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Licensee updated during visit but information is still incomplete. Licensee will maintain copy and submit copy to LPA by the POC due date of 5/17/19.
Type B
05/17/2019
Section Cited
CCR
102421
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Child's Records. This requirement is not met as evidenced by: Records not available for 1 child in care. See LIC811 for reference. This poses a potential risk to the health and safety of children in care.
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Per licensee, will ask parent to complete and return enrollment forms and maintain copy and submit copies to LPA by the POC due date of 5/17/19.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WANG FAMILY CHILD CARE
FACILITY NUMBER: 198011883
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2019
Section Cited
CCR
102416.5(e)
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Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). The requirement is not met as evidenced by: Upon arrival, LPA observed Licensee was alone caring for 6
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Per licensee, her husband who is her assistant stepped out about. Licensee called her spouse and he returned 35 minutes later. Licensee stated she understands staffing ratio and will maintain compliance at all times.

Deficiency corrected at time of visit.
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children, 4 of whom are under age 2, and 2 of whom are age 2. Licensee was over ratio by 1 infant. This poses an immediate risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4