198019921-6-15-2021-33-CC-MGAA-C4237G-20210615175957

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019921
Report Date: 06/15/2021
Date Signed: 06/15/2021 06:00:12 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 & HE FAMILY CHILD CARE		FACILITY NUMBER:	198019921
ADMINISTRATOR:	ZHI WU & QINA HE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 592-7558
CITY:	MONTEREY PARK	STATE: CA	ZIP CODE:	91755
CAPACITY:	14	CENSUS: 10	DATE:	06/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensees Qina He & Zhi Hu		TIME COMPLETED:	06:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Mireya García conducted an unannounced random inspection. At 1:17 p.m., LPA contacted Licensee via telephone and Licensee Zhi Wu answered phone and placed Licensee Qina He on the phone. LPA identified herself and explained the reason for the call. Licensee Qina informed LPA she will open door. At 1:20 p.m., LPA called Licensees back no answer. At 1:21 p.m., As no one open door LPA called Licensees back and Licensee Qina answer phone and stated, going to open door and soon after front door was open. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. During this inspection interpreting was provided by CTS Language link- Interactive Voice Response via telephone by translator Emily #10315 & Ivy #10926 in the language of Cantonese. LPA Garcia met with licensee, Qina who guided analyst on a tour of the facility. Licensee Qina states that there are currently 10 children enrolled. At 1:24 p.m., LPA observed two play yards in the living room area with infants inside sleeping. At 1:25 p.m., LPA entered nap room where LPA observed 3 cribs and 3 play yards being used by six children. LPA Garcia asked Licensee Qina if anyone else was in the home. Licensee Qina, indicated that husband was in Doctor’s office for TB and Licensee’s two children were upstairs. LPA Garcia then proceeded with tour of the home going downstairs (first floor) to the basement where at 1:27 p.m., LPA heard garage door open and asked LPA Qina to open door to see garage. LPA did not observe anyone inside the garage, LPA asked Qina who open garage door and Licensee stated, no one and pushed button to close garage door. LPA then asked Licensee to stop and open garage door, at 1:28 p.m., LPA Garcia entered and exited garage and walked towards the right side of the home where LPA observed Male holding two infants (Pictures were taken). LPA asked male for his name who was later identified as Licensee Zhi Wu. LPA Garcia asked Licensee Zhi why he was hiding with two infants, Licensee stated “I am sorry”. When LPA asked Licensee Qina why did she say husband was in Doctor, Licensee stated, 'I am sorry". LPA observed a total of seven (7) infants, three (3) preschool age children and Licensee’s two (2) own children present during this inspection. REPORT CONTINUES ON NEXT PAGE 1 OF 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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 & HE FAMILY CHILD CARE	FACILITY NUMBER: 198019921
	VISIT DATE: 06/15/2021

NARRATIVE

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Family members residing in the home are 2 adults (criminal record clearances on file) and 2 children.
This is a three-story home which consists of 4 bedrooms, 4 bathrooms, kitchen, dining room, living room has fireplace which was observed to be inaccessible, basement and garage. The children use the bathroom near the entrance hallway, living room, dining room and bedroom (nap room) area. Per licensee’s, areas off limits to children and parents include: 3 bedrooms,3 bathrooms, basement and garage. The LPA toured all areas used by children during this visit.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating central air for safety and comfort. There is one dog kept out of reach of children in the patio outside area of the home. There were safe toys, play equipment and materials observed for children. There are stairs to go downstairs (first floor) and stairs to go upstairs (second floor) of the home. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The licensee states that there are no poisons in the home. The licensee’s do understand that poison must be locked with a key or combination lock.

LPA observed and inspected sleeping equipment for infants. LPA observed that 3 cribs had wood attached to the sides of the crib (pictures were taken). Per Licensees they will remove cribs and leave four play pens for infant use. There are no objects hanging above cribs/play yards. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were observed to not be attached to anything. Licensees were advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensees. LPA Garcia also explained and issue to Licensees PIN 20-24-CCP Recently Approved Safe Sleep Regulations In Effect. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee’s, including but not limited to documentation that shall be maintained.

REPORT CONTINUES ON NEXT PAGE 2 OF 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

Page: 2 of 6

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 & HE FAMILY CHILD CARE	FACILITY NUMBER: 198019921
	VISIT DATE: 06/15/2021

NARRATIVE

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Per licensee Zhi Wu, there are two firearms in the premises that are kept in a safe located in the third floor of the home inside Licensee’s bedroom. LPA observed two firearms (Hand gun: Glock 19 and a Rifle Model: AR 15) kept under locked safe. Ammunition was observed to be stored in a separate locked compartment of the safe. Per Licensee’s there are no bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged serviced on 06/19/2020. Smoke detector and carbon monoxide detector in the dining room were tested and are in operable condition. The licensees have current Pediatric First Aid and CPR, which will expire 01/05/2022.

Incidental Medical Services (IMS) policy was discussed. Per Licensees, there are currently no children enrolled that required medication needs. 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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensees. Both Licensees have immunizations on file.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
REPORT CONTINUES ON NEXT PAGE 3 OF 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

Page: 3 of 6

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 & HE FAMILY CHILD CARE	FACILITY NUMBER: 198019921
	VISIT DATE: 06/15/2021

NARRATIVE

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· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.
LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

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

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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensees Zhi Wu & Qina He. The Licensee’s were provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. REPORT ENDS HERE PAGE 4 OF 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

Page: 4 of 6

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 & HE FAMILY CHILD CARE	FACILITY NUMBER: 198019921
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/16/2021 Section Cited	1 2 3 4 5 6 7	102416.5- (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:(1) Twelve children, no more than four of whom may be infants.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPAs observing that there were seven (7) infants present in the facility. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

Page: 5 of 6

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 & HE FAMILY CHILD CARE	FACILITY NUMBER: 198019921
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/21/2021 Section Cited	1 2 3 4 5 6 7	102417- Operation of a Family Child Care Home: (d) The home shall provide safe...materials.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPAs observing that three cribs in the nap room had wood attached to the sides of the crib (pictures were taken). This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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