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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017231
Report Date: 11/07/2019
Date Signed: 11/07/2019 02:57:11 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:WU FAMILY CHILD CAREFACILITY NUMBER:
198017231
ADMINISTRATOR:WU, QIAN YIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 839-2183
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:14CENSUS: 11DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Qian Yi WuTIME COMPLETED:
03:10 PM
NARRATIVE
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Random inspection conducted by LPA Jennifer Hua. LPA met with licensee, who guided LPA on a facility tour. Licensee speaks primarily Cantonese and little English. The facility is single-story 5 bedroom home. LPA observed 11 children in care supervised by Licensee and her assistant Yan Jan Wu (licensee's sister).

Areas accessible to children were inspected as follows: Family room, first bedroom(napping only), hall bathroom. Fenced patio. Primary care conducted in family room. Dining area is for eating only and fenced front yard may also be used for outdoor play.

Per licensee, there are no weapons, firearms, swimming pool or spa on the premise. The smoke/carbon detectors and fire extinguisher (2A 10BC) are in operable condition. Extinguisher was purchased on 10/16/19.

Areas off limits include: 4 bedrooms and fenced backyard, garage

-Licensee and assistant have current certificate in Pediatric First Aid/CPR which will expire on 9/8/20.
-Child Care Roster, Disaster Plan, Children records and required licensing forms were discussed and provided as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement.
The following was discussed: Individuals who are 18 years of age or older living/working in the home must be finger print cleared. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to 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
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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: WU FAMILY CHILD CARE
FACILITY NUMBER: 198017231
VISIT DATE: 11/07/2019
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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. LPA observed Child Care Liability insurance policy. Drills were conducted 6/21/19. Licensee was informed to complete the Mandated Reporter Training on department website at http://www.mandatedreporterca.com/ if training is available in her language.

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 deficiencies cited.
Exit interview was conducted with licensee.
Site visit notice posted. And 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: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2