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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014016
Report Date: 02/27/2023
Date Signed: 02/27/2023 12:22:51 PM


Document Has Been Signed on 02/27/2023 12:22 PM - It Cannot Be Edited

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:CHEN FAMILY CHILD CAREFACILITY NUMBER:
198014016
ADMINISTRATOR:CHEN, TIEN HSINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 297-8599
CITY:DIAMOND BARSTATE: CAZIP CODE:
91789
CAPACITY:14CENSUS: 3DATE:
02/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Tien Hsin ChenTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jennifer Hua conducted an unannounced Required - 1 Year on-site inspection. LPA was greeted by Licensee. A COVID-19 risk assessment was conducted. LPA stated the purpose of the visit and provided LIC 126 Entrance Checklist to facilitate the inspection. LPA was guided to a tour by Licensee. This is a two- story home. There are a total of 3 adults and 0 minor residing in the home. There were three children in care during the inspection 2 day care children and licensee's grand child. The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. Operating hours are Monday-Friday 8am -6pm. Per licensee, facility has been closed since the pandemic. Day care just re-opened this year January 2023. Licensee's spouse Scott Chen was also present.

All child care areas identified on the Facility Sketch were inspected to include the following:
· Childcare areas: Living room, family room, dining area, kitchen, hall bathroom and fenced backyard. Primary care is conducted in the family room.
· Off limit areas: Entire upstairs, there is a mesh netting at the bottom of stairs to block children from going up the stairs and front yard.

All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensees state that there are no poisons in the home. The licensees understand that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. The valve on the required 2A 10BC fire extinguisher indicates it was fully charged but has not been serviced annually. Smoke and carbon monoxide detector were tested and were operable.

Backyard is adequately fenced and there is no bodies of water on the premise.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
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: CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198014016
VISIT DATE: 02/27/2023
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Per licensee, there are no weapon on the premise. There are no dogs. There are age appropriate toys, equipment were observed for children. Posting requirements were observed to be posted at the time of inspection.

Children Forms/Records to Keep in Your Family Child Care Home were reviewed.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

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 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.

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



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.

All adults present have obtained a criminal record clearance. The licensee has proof of current pediatric first aid and CPR (expires: 1/7/2025). Licensee has not completed required mandated reporter due to language barrier. Licensee speaks Mandarin and some English, licensee stated she will complete training on line at www.mandatedreporterca.com for child care providers AB1207 . Roster reviewed. Per licensee, drills have not been conducted since she just re-opened they day care. She will conduct drills (Fire & Earthquake) by the end of this month and will document the date and time of each drill.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
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: CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198014016
VISIT DATE: 02/27/2023
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No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

INFANT CARE: The infant will sleep in the day care where they are constantly supervised. Appropriate sleeping arrangements and cribs will be available/observed. (one crib for each infant in care is required). Cribs or play yard will not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the time of each 15-minute LIC 9227 Plan shall be completed for each infant up to 12 months of age. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.


Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

Deficiencies cited during on attached 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee. Copy of report provided.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 02/27/2023 12:22 PM - It Cannot Be Edited

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: CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198014016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in fire extinguisher has not been serviced annually as required which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2023
Plan of Correction
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Per licensee, wil lpurchase a new one today and submit proof to LPA by the POC due date
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 children lack record which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Per licensee, will correct and submit copy to LPA by POC due date.
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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 02/27/2023 12:22 PM - It Cannot Be Edited

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: CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198014016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review, the licensee did not comply with the section cited above in form not signed by parent for child #1 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Per licensee, will have parent sign form at pick up today and submit copy to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5