414001667-12-5-2019-05-CC-JSAI-BJKQ4H-20191205105023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001667
Report Date: 12/05/2019
Date Signed: 12/05/2019 10:50:31 AM

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:	ZHANG, XIAOYAN		FACILITY NUMBER:	414001667
ADMINISTRATOR:	ZHANG, XIAOYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 873-0669
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY:	14	CENSUS: 8	DATE:	12/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Zhang, Xiayan		TIME COMPLETED:	11:00 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	Licensing Program Analyst (LPA) Saini met with Licensee XiaoYan Zhang for Annual/Random inspection today. Purpose of the inspection was explained to the Licensee. LPA inspected the physical plant with Licensee for health and safety hazards. Present there is Licensee and one helper taking care of 8 children in care ( 3 infants and 5 preschoolers). Adults living in the home are licensee, her husband, her daughter and her son ( son visit the house during college break). All adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances. Licensee owns home. Day care area: Living room, Kitchen and dinning area, bathroom#1 and backyard. Off Limit Area: Bedroom #1, Bedroom #2 bedroom #3 and bathroom #2 and bathroom #3 and garage. The day-care operates 8:00AM- 6:00PM Monday through Friday. Licensee has day-care insurance through Accord company LPA observed the following: The home appears to be clean and well maintained. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property. There is a fireplace in the day-care area which is properly barricaded. There are no detergents, or cleaning products accessible to day-care children. Licensee states there are no guns or weapons of any kind in the home. Licensee’s and her helpers CPR and First Aid expires on 12/02/2020. Emergency drills are conducted at least once every six months and properly logged. Last fire drill was done on 11/25/2019. Licensee provides daily snacks and meals. Children’s roster was reviewed and is complete and up-to-date. A copy of the roster is obtained during the visit. All children files were reviewed and are complete. All required postings are properly posted. Licensee and her helper has updated immunization's on file. .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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: ZHANG, XIAOYAN	FACILITY NUMBER: 414001667
	VISIT DATE: 12/05/2019

NARRATIVE

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During Inspection

*Incidental Medical Services (IMS) policy was discussed. As per Licensee, there is no children on special medication in her family child care.

*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption. pursuant to Health and Safety code 1596.7995 and 1597.662.

*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.

*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com) Licensee's and her helper's primary language is Chinese so both are exempted to take mandated reporter training.

*Licensee was given information regarding ‘Safe Sleep’ practices.

No deficiencies were issued today under Title 22 Division 12 of the CA. Code of Regulations.

This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.

Licensee was advised any additional questions to call Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

LIC809 (FAS) - (06/04)

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