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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845740
Report Date: 12/15/2021
Date Signed: 12/15/2021 03:19:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:HSIAO FAMILY CHILD CAREFACILITY NUMBER:
334845740
ADMINISTRATOR:HSIAO,WEI-HSINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 268-0906
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:14CENSUS: 5DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Wei Hsin HsiaoTIME COMPLETED:
03:10 PM
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On date and time listed, Licensing Program Analyst (LPA) Kim Leung arrived at the facility to conduct an annual inspection. The licensee's primary language is Mandarin. This inspection was therefore conducted in Mandarin. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:
Normal days and hours of operation are: Monday through Friday, 8am to 6pm

OFF-LIMIT AREAS INCLUDE: Master bedroom and master bathroom, laundry room and garage

· The facility is operating within the licensed capacity and appropriate ratios. Licensee was present at the home with 5 children,



· Appropriate supervision was provided during this inspection

· A working telephone is present and a current number was provided during the inspection.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection.

· Access to the fireplace is prevented by use of a piece of card board secured to the wall. Licensee stated that there is glass door behind the card board to properly screen the fireplace. Licensee states that the use of card board is to prevent children from bumping into the glass door.

· Regulatory of storage of hazardous items were reviewed with the licensee during inspection

· No weapons as stated by the licensee Wei Hsin Hsiao. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Single story home with no stairs

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HSIAO FAMILY CHILD CARE
FACILITY NUMBER: 334845740
VISIT DATE: 12/15/2021
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· Verification of control of property on file (Grant Deed)

· License, Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted

· Mandated Reporter Training completed/expired on 10/19/2021. However, licensee's primary language is Chinese Mandarin and the licensee states that she understands little English. The training itself is not available in Chinese yet. Licensee states that she would still complete the training if she is able to get assistance from a bilingual person.

· Pediatric CPR and First Aid Card expire in May 2023

· Health & Safety Certificate - completed on 7/22/2017

· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Clean, safe and age appropriate toys. Child care guidance during COVID-19 pandemic was reviewed with the licensee during the inspection.

· Current roster on file

· Documentation of fire and earthquake drills on file – Last drill conducted on 11/22/2021

· Children’s records are complete

· No employee at this time. This large family child care home is currently operating as a small family child care home with no more than 6 children attending at the same time as stated by the licensee

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed on 12/15/2021 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HSIAO FAMILY CHILD CARE
FACILITY NUMBER: 334845740
VISIT DATE: 12/15/2021
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· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee Wei Hsin Hsaio and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. No IMS was provided at this time as stated by the licensee. 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

- Licensee was reminded that all adults residents 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Family Child Care Home. Civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days may be assessed by the Department. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days.

- Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.



- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

No deficiency was cited at this time.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HSIAO FAMILY CHILD CARE
FACILITY NUMBER: 334845740
VISIT DATE: 12/15/2021
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The licensee Wei Hsin Hsiao confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the licensee Wei Hsin Hsiao.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4