198020536-7-3-2020-33-CC-JHUA-BR6NQE-20200703103950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020536
Report Date: 07/03/2020
Date Signed: 07/03/2020 10:40:08 AM

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:	XU & CHEN FAMILY CHILD CARE		FACILITY NUMBER:	198020536
ADMINISTRATOR:	B. XU & J.CHEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 267-2267
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	14	CENSUS:	DATE:	07/03/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	B. Xu & J. Chen		TIME COMPLETED:	10:07 AM

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	This was a pre-licensing inspection for change of location conducted by Jennifer Hua, Licensing Program Analyst (LPA) due to COVID-19 and precautionary measures. This pre-licensing inspection was conducted with Bing Yan Xu & Jian Sheng Chen, Applicants via a tele-inspection by use of (FaceTime). Applicants speak Cantonese. Applicants' daughter Ying Chen also was present to assist. Per applicants, no other individuals reside in the home. During this tele-inspection the Applicants took this LPA on a tour of the home. During this tour the following was noted: All areas identified on the facility sketch were inspected by tele-visit. This is a one story home consists of 4 bedrooms, 2 restrooms. living room, classroom(bedroom 4) , kitchen, wash room, garage, front yard, and backyard (fenced). Areas that are accessible to children are as follows: 3 bedrooms, 1 bathroom, living room, and backyard (fenced). Per applicants parents/children will enter the facility through the front door and back door. Areas off limits based on facility sketch submitted to children and parents include: 1 bedroom and 1 bathroom, kitchen, garage, wash room and front yard.. Rooms that are off-limits need to be made inaccessible during operating hours

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2020

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: XU & CHEN FAMILY CHILD CARE	FACILITY NUMBER: 198020536
	VISIT DATE: 07/03/2020

NARRATIVE

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Areas that will be used by children were inspected by tele-inspection for safety, comfort, cleanliness, telephone service, ventilation and heating (central). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible.

Per applicants, there are no pets, firearms, weapons, bodies of water on the premises. There are toys, books, furniture, cribs and cots available for children. The valve on the required 2A10BC fire extinguisher indicates fully charged purchased on 3/13/20 as observed on the receipt. Smoke and carbon monoxide detectors in the day care areas were tested and is operable.

Applicants have current Pediatric CPR and First Aid training as indicated on the certificate. Certificates will expire on 5/26/2021.

The applicants have proof of immunization against influenza, pertussis, and measles.
Applicants have not completed required mandated reporter training due to language barrier. Applicants were informed that Mandated reporter training shall be completed www.mandatedreporterca.com once it is available in their language.

The following was discussed with the applicants at:
Individuals who are 18 years of age or older living/working 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.

Reporting requirements, Safe Sleep were discussed. A Child Care Provider's Guide To Safe Sleep and Lead Poising Facts handout will be mailed to applicants.

Medication: 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

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2020

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: XU & CHEN FAMILY CHILD CARE	FACILITY NUMBER: 198020536
	VISIT DATE: 07/03/2020

NARRATIVE

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Fire Clearance has been approved.

The following shall be submitted prior to licensure:

1. Copy of Pediatric First Aid/CPR for applicants
2. Copy of vaccine record Measles, Pertussis and Flu or statement to decline for applicants.
3. Complete copy of LIC 610A to include 2nd Temporary Re-location.

LPA will also email applicants Resource Materials regard COVID-19.

Exit interview was conducted with applicants. This report will be sent to the Applicants via email with a read receipt or confirmation of receipt of email, which will act as the Applicants' signatures.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2020

LIC809 (FAS) - (06/04)

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