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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018431
Report Date: 09/01/2021
Date Signed: 09/01/2021 02:07:51 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: 10DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Ling Cao - LicenseeTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 9:40am, LPA met with licensee, Ling Cao. Also present during this inspection, is Li Zhang, Licensee’s Assistant. The licensee states that she currently has 11 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are Monday-Friday 7:30am-6:30pm.

This is a one-story home which consists of 2 bedrooms, 2 bathrooms, kitchen, living room, front yard and backyard (fenced). The children use the living room (used as activity space), bathroom by the back door leading to backyard, and backyard. Per licensee, areas off limits to children and parents include: bedrooms, one bathroom, garage. The licensee provides food for children in care.

The licensee states that 4 adults and 1 minor currently living in the home. Licensee states that she currently has one assistant. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT
At 9:55am, LPA was lead on a tour of the facility by the licensee. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted by the front door of the home. At 9:57am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and receipt taped to it noted a purchased 09/01/2021. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. In the front room, there are first aid supplies available. Fireplace is made inaccessible to prevent access by children. Living room has been organized to be the main child activity space. At 10:00am, LPA observed napping equipment in the form of cots. The bathroom by the back door was inspected and was observed to be clean and free of defects.

REPORT CONTINUES PAGE 1 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 7
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
VISIT DATE: 09/01/2021
NARRATIVE
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Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. At 10:05am LPA observed the back yard area. The outdoor play area was observed to be fenced and there was cushion material underneath the play equipment. Garage was made inaccessible to children in care by use of gates. At this time, children are using the back yard for outdoor play time.

Per licensee, the front room by the entrance will be used as an area for an ill child until an authorized representative comes to pick up child. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The licensee states that there is a land line on the premises. At 10:10am, the smoke and carbon monoxide detectors were tested. The Carbon monoxide detector and smoke detector were served to be operable. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:
The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 12/2020. Per licensee, they have had trouble finding in person training to renew their certificate. Licensee has completed Mandated Reporter Training that expires 02/2022. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Li Zhang does not have record of immunization against influenza, tuberculosis, pertussis, and measles present at the facility. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

All individuals present in the home have not obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Assistant Li Zhang does not have criminal record clearance and works in the facility. Per licensee, Li Zhang also resides in the home. Li Zhang was present at the facility assisting with the children in care upon LPA's arrival to the home. At 11:15am. LPA looked at the licensing system and observed that though fingerprints were received, the process was not completed prior to Li Zhang residing and working in the home. LPA discussed with licensee that it is their responsibility to ensure that an individual is cleared prior to allowing them to reside, work, or volunteer at the facility. Per licensee, Li ZHang has been living here since 04/2021.

REPORT CONTINUES PAGE 2 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
LIC809 (FAS) - (06/04)
Page: 2 of 7
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
VISIT DATE: 09/01/2021
NARRATIVE
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An immediate Civil Penalty of $500 is being assessed on this date. The Department's Guardian system was discussed, documentation to contact Guardian regarding Li Zhang's fingerprints was provided, and copies of licensing forms and photo ID for association are to be submitted to the Department.

The following was discussed:
-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are no pets on the premises
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Infant Care: Licensee states they are not caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):
Per licensee, there are no children enrolled that require IMS at this time. 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.

REPORT CONTINUES PAGE 3 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
LIC809 (FAS) - (06/04)
Page: 3 of 7
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
VISIT DATE: 09/01/2021
NARRATIVE
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LPA observed that a COVID-19 Technical Assistance call had been made on 08/05/2020. LPA observed health and safety practices being conducted at facility.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

Please refer to 809D for documentation of deficiencies.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.



Exit interview was conducted with Ling Cao, licensee, at 1:55pm and Plan of Corrections were reviewed and developed. A copy of the report was provided.

REPORT ENDS PAGE 4 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: 09/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2021
Section Cited

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"102416(d) Personnel RequirementsPrior to employment or initial presence in the child care home, all employee...shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations.... This regulation was not met as evidenced by:"
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Based on observation, interview, and file review, Licensee did not ensure that Assistant Li Zhang had criminal background clearance prior to working and residing at the facility. This poses an immediate risk to the health, safety, and personal rights 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 09/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2021
Section Cited

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102416(c)(1)(b) Personnel Requirements
A licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, ....
This requirement was not met as evidenced by:
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Based on interview and file review, Licensee did not ensure that her Pediatric CPR and First Aid Training was current. The Certificate notes expiration 12/2020. This poses a potential risk to the health and safety of children in care.
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Type B
10/01/2021
Section Cited

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1597.622(a)(1)
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.

This requirement was not met as evidenced by:
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Based on interview, Licensee did not ensure that there were records of the Staff #2 immunization against influenza, pertussis, and measles prior to working and residing in the home. This poses a potential risk to the health, safety, and personal rights 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: 09/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2021
Section Cited

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102369(b)(9) Application of Initial License
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
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Based on interview and file review, Licensee did not ensure that Staff #2 had record of negative TB Testing in their file. This poses 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7