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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018431
Report Date: 01/14/2020
Date Signed: 01/14/2020 03:01:01 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:CAO & CHIANG FAMILY CHILD CAREFACILITY NUMBER:
198018431
ADMINISTRATOR:CAO,LING YAN & CHIANG,BOBFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 513-0168
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:14CENSUS: 12DATE:
01/14/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yan Ling Cao & Bob ChiangTIME COMPLETED:
03:15 PM
NARRATIVE
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An unannounced Case Managment-Deficiencies Inspection was conducted on this date by Cynthia Reyes, Licensing Program Analyst (LPA). Met with Yan Ling Cao & Bob Chiang who took LPA on a tour of the facility.

The deficiency observed and being cited on this date are, Incomplete children's roster, children's files are missing forms, no file at all or no signature, dates or information completely filled out and carbon monoxide not working properly.

Please refer to 809D for documentation of deficiencies.

An exit interview was conducted, appeal rights given and a copy of this report was also provided.

Upon receipt, the Licensee shall post the Notice of Site Visit and the Licensing report. This report and the Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2020
Section Cited

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Operation of a Family Child Care Home. All homes shall have a current roster of the children. This requirement is not met as evidenced by LPA observed and request a current roster, however the roster is not up to date. This poses a potential health and safety risk to the children in care.
Type B
01/27/2020
Section Cited

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Child Records: Licensee shall maintain in each child's file all the required and completed forms with signature and dates from the department. This requirement is not met as evidenced by: file review of several children files not being complete. This is a potential risk to the health and safety of children in care.
Type B
01/27/2020
Section Cited

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Carbon monoxide detectors required; inspection. Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standard regulation. This requirement is not been met as evidenced by LPA observed the Carbon monoxide not working properly during the inspection.
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This is a potential 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2020
LIC809 (FAS) - (06/04)
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