198019921-6-21-2021-33-CC-RLOZ-C483AD-20210621180434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019921
Report Date: 06/21/2021
Date Signed: 06/21/2021 06:04:40 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:	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: 9	DATE:	06/21/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Licensee's Zhi Wu & Qina He		TIME COMPLETED:	06:10 PM

NARRATIVE

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On June 21, 2021, Licensing Program Analysts (LPAs) Roxana Lopez and Mireya García, conducted an unannounce POC (Plan of Corrections) inspection to address the Type A and B deficiencies cited during visit conducted on June 15, 2021. During this inspection interpreting services was provided by CTS Language link- Interactive Voice Response via telephone by translator Carmen # 10417 in the language of Cantonese.

At 3:40 p.m., LPA Garcia contacted Licensee Qina He to inform Licensee that LPAs where outside the premises. At 3:41 p.m., LPA Garcia called Licensee Qina as Licensee was not opening door, however, Licensee Qina did not answer. LPA Garcia rang door bell and at 3:42 p.m., LPA Lopez and Garcia were greeted by Licensee Zhi Wu who open door. Upon arrival LPA's observed four (4) infants, three (3) preschool age and two school-age children with Licensee Zhi Wu. At 3:45 p.m., Licensee Qina arrived and guided LPAs on a tour of the facility. Per Licensee, Qina wife was picking up groceries. A civil penalty of $250 was assessed on this date for a repeated violation.

At this time the Licensees, are not in compliance with Title 22. The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

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. Licensees 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 licensees.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

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: 06/21/2021

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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.

Exit interview was conducted with Qina He and Zhi Wu, Licensees including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

Report ends here page 2 of 2----------------------------------------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: 06/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/21/2021 Section Cited	1 2 3 4 5 6 7	102416.5(d)(1) 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) (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 LPA's observion that there were four (4) infants, three (3) preschooler's and two (2) school age children present in the facility with one (1) adult providing care and supervision. This poses and 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: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC809 (FAS) - (06/04)

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