198017194-7-10-2019-33-CC-JHUA-BDXQQJ-20190710122224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017194
Report Date: 07/10/2019
Date Signed: 07/10/2019 12:22:32 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:	CHEN FAMILY CHILD CARE		FACILITY NUMBER:	198017194
ADMINISTRATOR:	CHEN, HUI LAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 673-8001
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91776
CAPACITY:	14	CENSUS: 12	DATE:	07/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Wendy Chen Hui Lan Chen		TIME COMPLETED:	12:30 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	Annual Random inspection conducted by LPA Jennifer Hua. Upon arrival, LPA met with 3 assistants. Assistant Wendy Chen guided the analyst on a tour of the facility. The facility is a two-story home with 4 bedroom and 4 bath. Licensee returned shortly. Licensees speak primarily Cantonese and Mandarin. This visit was conducted in Cantonese. Per licensee, total 4 adults reside in the home and 0 minors. All adults present have fingerprint clearances on file. All assistants have current Pediatric First Aid/CPR certificate. Areas used by children were inspected as follows: living room, dinning area, family room, 2 bathrooms, fenced backyard. 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 purchased on 2/21/19. Areas off limits include: downstair bedroom, kitchen, and entire up stair level and fenced front yard. Stair is barricaded. Licensee is current in CPR/Pediatric First Aid training. Certificate will expire on 1/6/2020. -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 Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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: CHEN FAMILY CHILD CARE	FACILITY NUMBER: 198017194
	VISIT DATE: 07/10/2019

NARRATIVE

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The following was discussed: Individuals who are 18 years of age or older living/working in the home must be finger print cleared prior to being on the premise. Individuals within one month of their 18th birthday must be fingerprinted immediately. An immediate $100 per day Civil Penalty, for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the Department a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.
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. Drills conducted on 6/12/19. Affidavit Regarding Liability Insurance in files.
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.
No deficiency cited.
Exit interview was conducted with licensee. Notice of Site visit form posted by front entrance. Licensee advised to keep notice posted for 30 days or a civil penalty of $100 will be assessed.
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 Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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