198020460-3-6-2020-33-CC-BBEL-BMFSNJ-20200306130137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020460
Report Date: 03/06/2020
Date Signed: 03/06/2020 01:01:57 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:	CHENG FAMILY CHILD CARE		FACILITY NUMBER:	198020460
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	03/06/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Applicant Yi Ling Cheng		TIME COMPLETED:	01:00 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	An announced Pre-licensing inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell. The inspection was conducted in English, as applicant is bi-lingual, being fluent in both English and Mandarin. Upon arrival, LPA was greeted and let into the residence by applicant, to whom the reason for the inspection was announced. Aoplicant's proposed days and hours of operation are Monday-Friday, 7:00 A.M.-6:00 P.M. At this time, applicant is proposing to care for children ages 0-6. This is a two-story, single family residence with four bedrooms and two and half bathrooms. All areas identified on the facility sketches were inspected in the following order: (indoors): (upstairs): bedroom #1, bathroom #1, bedrooms #2-4, bathroom #2, (downstairs): the kitchen, the living room, the laundry room, the garage, bathroom #3, the family room and then (outdoors): the backyard. The areas which have been designated off-limits are: (indoors): the entire second floor, the kitchen, the laundry room, the garage (outdoors): the two dog runs and the entire area surrounded by wrought iron fencing. The second floor is rendered inaccessible by a permanently-mounted baby gate at the bottom of the stairs. The kitchen is rendered inaccessible by one removable baby gate and one permanently-mounted baby gate. The laundry room is rendered inaccessible by a chain latch. The garage is rendered inaccessible by a lock.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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 5

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

Page 2/5

Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (licensee only has a cell phone), heating and ventilation (there is central heating and air-conditioning and in the living room, a ceiling fan), inaccessibility to poisons, detergents (they are kept in the laundry room), cleaning compounds (they are kept under the kitchen sink),
medicine and other hazardous items that can pose a danger to children.

Toys and napping equipment: There are age-appropriate toys and napping equipment on the premises. Applicant has six cots and one play yard in addition to two couches on which the children can nap.

Parent Board: The Parent Board is on the wall directly next to the entryway. LPA provided applicant with the Notification of Parents Rights and applicant has a copy of her Emergency Disaster Plan.

Pets: Applicant has two Huskeys, which will be kept in a cage in the south dog run during daycare hours. Applicant states that she has their vaccination records on file and that they are current.

Fire safety: There are two smoke detectors on the premises: one in the hallway upstairs and one on the ceiling in front of the laundry room downstairs; both were tested and are operable. There is an electric carbon monoxide detector pluggged into the outlet outside of the laundry room; it was also tested and is operable. There is a piece of cardboard and fireplace screen in front of the fireplace; there is a bookcase in front of the fireplace screen, rendering it inaccessible.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

Page 3/5

Transportation: Applicant stated that at this time, she will not provide transportation

Firearms: Applicant stated that there are currently no weapons or firearms on the premises.

Incidental Medical Services: 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

There is one First Aid Kit, which is kept in a drawer in the bathroom which will be used by the daycare children.

Backyard: The backyard is completely surrounded by a brick wall.

The following was discussed: Individuals who are 18 years of age or older living in the home must be fingerprint cleared prior to licensure. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to an immediate abuse clearance, and criminal records transfer requirements.$100 per day Civil Penalty, for a maximum of 5 days for the 1st violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

Page 4/5

Department, a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.

No smoking; no infant walkers, Johnny jumpers, exersaucers and any other items that fall into that category; earthquake & fire disaster drills and safety; posting requirements; children's records requirements; mandated child abuse and injury/death reporting; criminal records, child

The following sample forms packets were provided and explained:

Children's Records: LIC 311D Forms/Records To Keep In Your Family Child Care Home; LIC700 Identification and Emergency Information; LIC702 Child's Pre-Admission Health History; LIC995E Caregiver Background Check Process; LIC995A Notification of Parents Rights; LIC995E Caregiver Background Check Process; LIC9212 Family Child Care Consumer Awareness Information; PM286 California School
Immunization Record; LIC627 Consent for Emergency Medical Treatment; LIC613A Personal Rights; LIC282 Affidavit Regarding Liability Insurance; and LIC9150 Parent Notification, Additional Children in Care

Facility Records: LIC 311D Information To Be Posted In Your Family Child Care Home; LIC9149 Property Owner/Landlord Consent; PUB394 Notification of Parents Rights; PUB269 California Child Passenger Safety Law; LIC9040 Facility Roster; LIC610A Emergency Disaster Plan; LIC9148 Earthquake Preparedness Checklist; a sample fire, earthquake, and smoke detector drill record; LIC624B Unusual Incident/Injury Report; PUB271 Never Shake A Baby; "Reduce the Risk of Sudden Infant Death Syndrome" pamphlet; "Safe Sleep Policy for Infants in Child Care Programs" and "A Safer Generation of Cribs" and "Your Guide to New Crib

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

Page 5/5

Standards" by US CPSC as well as the Lead Facts Flyer.

Staff Records: LIC 311D Facility Forms/Records; LIC508 Criminal Record Statement, LIC501 Personnel Record, LIC503 Health Screening/TB, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse, LIC9163 Request for LIVESCAN, LIC9188 Criminal Record Exemption.

Paperwork: Applicant provided a copy of her 2019 Property Tax statement and LPA viewed her California Driver's license as verification of control of property. Applicant completed online Family Child Care Home orientation on 09/27/19. Applicant completed an EMSA-approved Preventative Health and Safety course on 10/20/19. Applicant's Pediatric First Aid/CPR were issued by the American Heart Assocation and expire 10/21. Applicant completed the Mandated Reporter Training on 11/10/19. Applicant provided verification of MMR and TDAP and influenza immunizations.

During today's inspection, applicant provided LPA with new Yard and Floor Plan sketches.

As of today, the residence appears to be in compliance and meet Title 22 Regulations and appears ready for licensure.

An exit interview has been conducted with and a copy of this report has been signed by and provided to Applicant Yi Ling Cheng.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 5 of 5