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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018182
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:18:46 PM


Document Has Been Signed on 12/12/2023 04:18 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LU FAMILY CHILD CAREFACILITY NUMBER:
198018182
ADMINISTRATOR:LU, YIN HONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 734-8039
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:14CENSUS: 2DATE:
12/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Yin Hong Lu, LicenseeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Thelma Razo conducted a Required - 1 Year inspection and was greeted by Licensee Yin Hong Lu. LPA stated the purpose of the visit. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to the licensee who guided analyst on a tour of the facility. Also present was Licensee's mother, Xiuying Sun, and father Huacheng Lu. LPA observed two (2) children at the time of inspection. Per Licensee, nine (9) children are currently enrolled. A current children roster was provided to LPA.

This is a two story home which consists of 4 bedrooms, 4 bathrooms, living area, dining area, kitchen, rear family room and attached garage. Children have access to the living/dining room area, one bathroom and the rear family room all located on the first floor. The entire second floor was barricaded by a safety gate and was off-limit to children in care. Other off limit areas are the kitchen, one (1) bedroom, one (1) bathroom, and attached garage. The home was inspected for safety, comfort, cleanliness, ventilation, and availability of telephone service.

Adults residing in the home are Licensee, mother, father, one adult son and two minor children. LPA observed said adult individuals have obtain a criminal record clearance or exemption prior to working, residing or volunteering in this home.

LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LU FAMILY CHILD CARE
FACILITY NUMBER: 198018182
VISIT DATE: 12/12/2023
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The home was observed to be clean and orderly, with central air and heating. LPA observed the smoke detector and the carbon monoxide detector to be in operable condition. LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchase on 7/23/23. Last disaster drill documented was conducted on 11/25/2023. The home maintains telephone service via land line and cell phone. There are toys and other age-appropriate material available for children. Licensee prepares lunch, snack, and dinner. LPA observed a first aid kit in the facility.

Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, to be made inaccessible to children. Per Licensee there are no firearms or weapons stored in the home and no bodies of water. LPA reminded licensee that smoking is not allowed in the home.

Child’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights.



Licensee file was reviewed for the following: LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Pediatric First Aid and CPR certification on expires 08/27/24.

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.


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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LU FAMILY CHILD CARE
FACILITY NUMBER: 198018182
VISIT DATE: 12/12/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee's do have proof of immunization against influenza, pertussis, and measles.

LPA advised the licensee how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/process.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



There’s no deficiency cited under California Title 22 Regulations during this inspection.

Exit interview was conducted with Licensee. Copy of report and Appeal Rights (LIC 9058) provided.


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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
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