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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018760
Report Date: 06/19/2019
Date Signed: 06/19/2019 04:13:40 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:ZENG FAMILY CHILD CAREFACILITY NUMBER:
198018760
ADMINISTRATOR:ZENG, SHIRONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 376-6977
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY:14CENSUS: 8DATE:
06/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Jiayuan Wu & Shirong ZengTIME COMPLETED:
04:20 PM
NARRATIVE
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An unannounced Random inspection was conducted on this date by Licensing Program Analyst (LPA) Jennifer Hua.

Upon arrival, LPA was greeted and let into the residence by licensee's spouse Jiayuan Wu, who was alone with eight children: Three infants, and 5 preschool age children. Children were napping. Mr. Wu stated that his wife is not here. Licensee returned to facility at 2:32pm. Licensee stated due to back pain, she left to get treatment. Licensee was informed that she cannot leave her husband alone with 8 eight children with 3 infants and 5 preschool age children. Licensee stated this was the only time she left.

Licensee's hours of operation are Monday-Saturday, 8:00 A.M. to 6:00 P.M. Child care areas identified on the facility sketch, both inside and outside, were inspected. This is a single-story residence with three bedrooms and two bathrooms. The family members residing at the facility are three adults. The facility was inspected in the following order: indoors: living room, hall area, hall bathroom, 1 bedroom, and the patio room. The residence was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicine, and hazardous items that can pose a danger to children. All detergents, cleaning compounds, and toiletries are rendered inaccessible. There are no stairs in the residence. For outdoor play, children use fenced backyard. Licensee has a fully charged fire extinguisher, size 2-A:10-B:C, which is kept in the kitchen, but has not been serviced annually. It was last serviced on 08/29/17. The kitchen is rendered inaccessible by a baby gate.

There are age-appropriate toys and napping equipment (i.e. play pens and small mattresses. The last fire/ earthquake drill was run on 5/13/19. Licensee and her spouse's Pediatric First Aid & CPR certificate expired on 06/10/19. There is a functional smoke/carbon monoxide detectors on the premises.
Per licensee, there are currently no firearms or other weapons on the premise. There is no swimming pool and no bodies of water on the premise.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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 4
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: ZENG FAMILY CHILD CARE
FACILITY NUMBER: 198018760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2019
Section Cited
CCR
102416(c)(1)(a)
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Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. The requirement is not met as evidenced by: Licensee and her assistant (spouse)
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Per licensee, will renew certificate, and submit copy to LPA by the POC due date of 7/19/19
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certificate expired on 6/10/19. This poses a potential risk to the health and safety of children in care.
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Type B
06/24/2019
Section Cited
CCR
102417(g)(1)
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Operation of a Family Child Care Home. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. The requirement is not met as evidenced by: LPA observed fire extinguisher is fully but has not been serviced annually. This poses a potential risk to the health and safety of children in care
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Per licensee, will get it service and submit copy of service tag and invoice to LPA by the POC due date of 6/24/19.
Type B
06/20/2019
Section Cited
CCR
102417(g)(7)
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Operation of a Family Child Care Home. The Licensee shall maintain copy of the parent's authorization for the licensee or registrant to consent to emergency medical care. The requirement is not met as evidenced by: Child # 1, 4, 6 & 8, consent form not completed. This poses a potential risk to the health & safety of children in care.
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Per licensee, will have parents sign form and maintain copy in file and submit copies to LPA by the POC due date of 6/20/19
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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ZENG FAMILY CHILD CARE
FACILITY NUMBER: 198018760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2019
Section Cited
CCR
102416.5(e)
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Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). The requirement is not met as evidenced by: Upon arrival, LPA observed Licensee's spouse was alone with
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Per licensee, she understands the required ratio, but due to extreme back pain, that's why she left to get treatment today. Licensee stated she is always here, this is an isolated incident.

Deficiency corrected during visit.
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 8 children, 3 of whom are under age 2, and 5 of whom are of preschool age. Facility was over ratio by 2 preschooler. This poses an immediate 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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: ZENG FAMILY CHILD CARE
FACILITY NUMBER: 198018760
VISIT DATE: 06/19/2019
NARRATIVE
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the premises. The files of children were reviewed for the required forms. Affidavit Regarding Liability Insurance form in children files. A Child Care Provider's Guide to Safe Sleep was provided.
Required postings were observed on the Parent Board.
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

**During today's visit, the LIC 811 Confidential Names list was provided to Licensee.**

Licensee is required to adhere to the terms and limitation as stated on the license.

The following is being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for documentation of deficiencies.
Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. 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.
3. 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).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.
An exit interview was conducted with license, and a copy of this report provided. Appeals rights provided and explained.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4