198020460-7-7-2021-33-CC-BBEL-C4PSLV-20210707135858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020460
Report Date: 07/07/2021
Date Signed: 07/07/2021 01:59:11 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: 6	DATE:	07/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Licensee Yi Ling Cheng		TIME COMPLETED:	02:00 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 unannounced, in-person Annual/Required-1 year (Case Management-Licensee-initiated) 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. The purpose of the inspection is because Licensee is requesting an increase in capacity from a small (capacity 8) to a large (capacity 14) and because the Department is now conducting annual inspections. Licensee qualifies because she has been licensed at this residence since 03/11/20. Upon arrival, LPA was greeted and let into the residence by Licensee Cheng, to whom the reason for the inspection was announced. Licensee's spouse was also present the duration of the inspection. At 10:15, LPA began the tour of the premises. Census: Staff-child ratio was met. (See 811 for details.) Licensee's days and hours of operation are Monday-Friday, 8:00 A.M. to 06:00 P.M. 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): (downstairs), the living room, bathroom #3, the family room and then (outdoors): the backyard. The areas designated as off-limits were not inspected: (indoors): the entire second floor, the kitchen, the laundry room, the garage and (outdoors): the two dog runs and the entire area surrounded by

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 07/07/2021

NARRATIVE

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wrought iron fencing.

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. LPA observed three cots and two play yards on/in which the children nap.

Parent Board: The Parent Board is on the wall directly next to the entryway. LPA observed the Notification of Parents Rights, the Emergency Disaster Plan and the license, as well as the COVID-19 posters posted.

Pets: Applicant has two Huskeys, a rabbit and a hamster. The rabbit and hamster are kept in cages in the living room. The two Huskeys were in a cage in the garage.

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. Both smoke detectors and the carbon monoxide were tested and are operable. The fire extinguisher is mounted in the kitchen; it was last serviced 03/22/21. It is size 2-A:10-B:C.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 07/07/2021

NARRATIVE

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Transportation: Licensee stated that at this time, she does not provide transportation

Firearms: Licensee 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. Artificial grass provides cushioning material underneath the swing set.

Paperwork: Licensee's roster was current and complete. Licensee's Pediatric First Aid/CPR cards were issued by the American Heart Assocation and expire 10/21. Licensee completed Mandated Reporter Training on 11/10/19.

As there are five children enrolled, all five files were reviewed for the required forms. One file (of the one required) is missing the required documentation of the 15-minute check during naptime. All five files were missing the copies of the immunization record.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
	VISIT DATE: 07/07/2021

NARRATIVE

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The capacity increase will not be granted until the deficiencies issues are cleared.

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

The Notice of Site Visit was posted by Licensee in LPA's presence. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.

An exit interview has been conducted with and a copy of this report has been signed by and provided to Licensee Yi Ling Cheng. Appeal Rights were providedto and explained to Licensee as well.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: CHENG FAMILY CHILD CARE	FACILITY NUMBER: 198020460
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/19/2021 Section Cited	1 2 3 4 5 6 7	Infant Safe Sleep Documentation shall be maintained in infant’s file and be available to the Department for review. Documentation shall include the following: a. Date. b. Infant’s name. c. Time of each 15-minute check.
	8 9 10 11 12 13 14	-This requirement is not met as evidenced by: the file of the one infant enrolled (C5) dic not contain the documentation of the 15 minute check.	8 9 10 11 12 13 14
Type B 07/19/2021 Section Cited	1 2 3 4 5 6 7	IMMUNIZATIONS The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
	8 9 10 11 12 13 14	-This requirement is not met as evidenced by; the files of all five children enrolled did not contain a copy of the immunization record.	8 9 10 11 12 13 14

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

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