384004382-3-25-2021-05-CC-FBTQ-BZFU7Z-20210325152042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004382
Report Date: 03/25/2021
Date Signed: 03/25/2021 03:20:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ZHEN, JIANCI		FACILITY NUMBER:	384004382
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	03/25/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jianci Zhen		TIME COMPLETED:	12:30 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	Licensing Program Analyst (LPA), Farhan Bashir-Tariq conducted a scheduled PreLicesing inspection today 3/25/21 and met with Applicant, Jianci Zhen. This inspection was conducted via Face Time due to COVID-19 restrictions. Purpose of the inspection was explained. LPA verified the background check clearance of adults working or living in the home. Licensee rents the home, which is a two bedroom and two bathrooms house. Hours of operation will be: M-F, 8:00 am- 6:00 pm. Applicant will provide breakfast, lunch and two snacks. Daycare areas: Upper Level: Bedroom #2, Bathroom #2, Living room #2/ Main play area, and Playground #1 & #2 on lower deck. OFF limit areas: All ground floor areas including Garage, Bathroom #1, Bedroom #1, Gym area, Sink area and Living room #1. Upper Level: Kitchen and Closet LPA and Applicant virtually inspected the entire home for health and safety hazards. All off limit areas were properly barricaded and made inaccessible to the children in care. There is no front yard attached. Electric shut offs are located by the main front door. Main childcare area is located on upper level. Stairs leading to upper level have been blocked off with a baby gate at top. Windows located in play area have been secured with built in locks. Kitchen on upper level is located next to play area, which has been blocked off with a baby gate. Toxins and Chemicals were stored in a locked closet on upper level. All harmful and sharp objects were made inaccessible from children in care. License and other required licensing documents will be posted on upper level near the stairs. Home was observed to be clean and orderly with enough lighting and ventilation. LPA observed that there were plenty of toys, books, arts, crafts and other learning materials available in the home. Bedroom #2 opens out to upper deck area, which have stairs leading to lower deck. Both playgrounds located on lower deck will be used for children in care. Both playground and all the area around upper and lower deck have been blocked off with fence and baby gates thus making it secure to be used for children. Soft cushioning was installed in playgrounds around the slides to prevent any falls or injuries. One side of lower deck will be in Applicant’s personal use. This side has been blocked off and separated by fence from childcare area. Home has multiple smoke and carbon monoxide detectors available. Applicant tested one of the detectors for this inspection. A working telephone and a fully charged fire extinguisher of size 2A10BC or bigger is also available in the home. First Aid Kit was available and fully stocked. Applicant states that are no firearms or weapons present in home. Per Applicant, there are no bodies of water/ swimming pools in the home. Per Applicant, she doesn’t have any pets in the home. Page...1

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZHEN, JIANCI	FACILITY NUMBER: 384004382
	VISIT DATE: 03/25/2021

NARRATIVE

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Applicant was reminded to conduct and log a fire and emergency drill once every six months. Applicant has a current and valid First Aid and CPR card expiring in July 2022. Applicant has also completed her mandatory child abuse training on 2/13/21. This training is valid for two years. Applicant was reminded of NO walkers, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Applicant was reminded about the Provider Information Notices (PINs) on the CCLD website. During the inspection, LPA also provided information and assistance about issues related to COVID-19. Applicant was reminded to clean and disinfect childcare areas thoroughly at least once a day. Applicant was instructed to post COVID-19 symptoms and social distancing posters in childcare area and hand washing poster in bathroom.

LPA reminded Applicant that all adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty. LPA reminded Applicant that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reminded Applicant , as of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA encouraged Applicant to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

This report was discussed and explained to Applicant. Records to be maintained in the facility were discussed and a copy of Form 311D was emailed to Applicant. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parent's Rights Poster. Capacity limits of a small Family Child Care license has been discussed. A handout explaining capacity and ratio was emailed to Applicant along with this report.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ZHEN, JIANCI	FACILITY NUMBER: 384004382
	VISIT DATE: 03/25/2021

NARRATIVE

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Small Family Child Care Home license is pending and will be approved upon receiving the following items:

i. Pictures of handwashing poster in bathroom.
ii. Pictures of mask requirement and social distancing posters in childcare.
iii. Electric outlets secured with child safety covers in bedroom #2 and bathroom #2.
iv. COVID-19 Self-Assessment Guide completed by Applicant.
v. Applicant’s immunization record for MMR.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available M-F, 8AM-5PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC809 (FAS) - (06/04)

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