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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001816
Report Date: 01/19/2022
Date Signed: 01/19/2022 12:46:16 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:LU, RITA RUEY-TINGFACILITY NUMBER:
414001816
ADMINISTRATOR:LU, RITA R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 577-1715
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 10DATE:
01/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Rita Ruey-Ting LuTIME COMPLETED:
01:00 PM
NARRATIVE
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On 1/19/2022 at 9:20A.M. Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Rita Lu. Purpose of the inspection was explained and is for an unannounced Annual/Random inspection. Present was the licensee and two helper caring for ten children. (2 Infant Age, 8 Preschool Age). All adults present have their criminal record clearances on file. Licensee’s home is a six bedroom, three bathroom, two story house. Days and Hours of operations are: Monday – Friday, 8:30 A.M., to 5:30 P.M. Day-care Areas: 1st Floor: Living Room (Playroom), Bathroom #1, Bedroom #1, Outdoor Play Area, Family Room (Pass through only), and Kitchen (Pass through only). Off-limit Area: Entire 2nd Floor: Bedroom #2, Bedroom #3, Bedroom #4, Bedroom #5, Bedroom #6, Bathroom #2, Bathroom #3 and First Floor: Garage. LPA inspected home inside and outside, with the licensee for health and safety hazards.

At 9:25A.M., LPA observed the following: Day-care was clean, orderly with variety of age appropriate books, blocks and games for the children. Furniture and playthings inspected were in good repair. Individual cubbies are located in the entry for children’s belongings. LPA observed child size tables and chairs for snack and activities. Floor in playroom has been carpeted for added safety. For napping services, sleeping bags and supplies are located in bedroom #1. Per licensee, napping supplies are taken home weekly to be cleaned. Bathroom #1 was maintained clean with adequate supplies for the children. Bathroom fixtures were in operating condition. Facility was the proper temperature with ventilation and natural lighting. Off-limit areas have been made inaccessible with child safety gates. LPA observed detergents, cleaning compounds and other items which could pose a danger, stored in an off-limit areas. Home had a functioning cell phone, smoke / carbon monoxide detector and fully charged fire extinguisher (3A:40BC), located in the entry way.

At 10:00A.M., LPA inspected the Outdoor Play Area. Area was completely enclosed with tall fencing. LPA observed a shaded rest area available to the children. Per licensee, drinking water is made readily available to children at all times. LPA reminded licensee to remove broken toys and equipment from outdoor play area. Play structure and swing set was securely anchored. Licensee's does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water. (REFER TO 809-CFOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
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 6
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: LU, RITA RUEY-TING
FACILITY NUMBER: 414001816
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA confirmed required mandated reporter training certifications missing from all staff files. This poses a potential health safety risk to children in care.
POC Due Date: 02/04/2022
Plan of Correction
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Licensee and facility staff will complete the required mandated reporter training by the due date: 2/4/2022. Proof on correction will be submitted to the department via email.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interviews conducted, LPA confirmed licensee and facility staff did not have their current CPR/ First Aid certification on file.

. This poses a potential health and safety risk to children in care.
POC Due Date: 02/04/2022
Plan of Correction
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Licensee will complete required CPR/ First Aid Certification Course by the due date: 2/4/2022. Proof of correction will be submitted to the department via email.
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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: LU, RITA RUEY-TING
FACILITY NUMBER: 414001816
VISIT DATE: 01/19/2022
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(Page 2)

At 10:15A.M., LPA conducted facility records. Staff records included: Employee information, Notice of Employee Rights and Criminal Record Statement. At 10:17A.M., Based on record review, LPA confirmed staff file, S2, missing proof of required employee immunization. During inspection, Advisory Note: Technical Violation (LIC 9102TA) was issued.

At 10:20A.M., Based on record review, LPA confirmed required mandated reporter training certifications missing from all staff files.

At 10:25A.M., Based on record review and interviews conducted, LPA confirmed licensee and facility staff did not have their current CPR/ First Aid certification on file.

Children's records included: (LIC700) Identification of Emergency Information, (LIC627) Consent for Medical Treatment and (LIC995A) Notice of Parent's Rights. LPA reminded licensee to regularly update the children’s immunization records.

LPA reminded licensee to conducted required Emergency Disaster Drill every 6 months, logging the event. Children's Roster (LIC 9040) was properly updated during inspection.

LPA observed required forms visibly posted in the playroom. Posted forms including the Facility License, Emergency Disaster Plan, and Parent’s Rights. Licensee stated parents provided all daily snacks and meals. Per licensee, there are no children in care require lifesaving medication. LPA reminded licensee to label all children food containers. Per licensee, there are no guns or weapons in the home.

Licensee was reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/ per person will be assessed if this regulation is violated. (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: LU, RITA RUEY-TING
FACILITY NUMBER: 414001816
VISIT DATE: 01/19/2022
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LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (REFER TO 809-C, FOR CONT.)

Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Health and Safety code of Regulations, and cited on the attached 809- D. Exit interview was conducted and plan of correction was reviewed by Licensee, Rita Lu, and her signature of this form acknowledges receipt of these documents. Notice of Site Visit was provided and must be posted for 30 days.



>This report and rights to comment and appeal were discussed with licensee. This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Websit
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6