414002549-7-10-2019-05-CC-GSIH-BDY2V2-20190710174314

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002549
Report Date: 07/10/2019
Date Signed: 07/10/2019 05:43:19 PM

COMPREHENSIVE INSPECTION

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:	XU, JUN		FACILITY NUMBER:	414002549
ADMINISTRATOR:	XU, JUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 249-0298
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94065
CAPACITY:	14	CENSUS: 10	DATE:	07/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Xiaoling Deng, Yuefang Chen & Zhifang Ma		TIME COMPLETED:	02:45 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 Analysts (LPAs) Singh and Ly met with helper, Xiaoling Deng and Yuefang Chen, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in an apartment. Present, there are ten (Three infants, eight pre school age) children in care. Licensee’s daughter, Zhifang Ma, arrived at the facility during the inspection. All adults living or working in the home have criminal background check on file. Licensee provides day care from Monday to Friday between 8 AM to 5:45 PM. LPAs inspected the day care areas with the helper, Xiaoling Deng. Day Care Areas: Living Room, Dining Room, Kitchen, Kid Reading room, Bedroom, Bathroom and Side yard. There is no pool, spa or any other body of water in the house. There is water fountain with water pond in the apartment complex. Licensee’s apartment has fence around the play area. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Cabinets in the bathroom and kitchen have child protective locks installed. Fireplace is barricaded with furniture. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. At 1:40 PM, LPA review the children's record. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. LPAs observed licensee has log for drills being conducted. Per log, last drill was conducted on January 25, 2019. Licensee’s immunization records were checked during previous inspection. Helper Xiaoling Deng has valid CPR on file until 2021. LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. See next page for continuation ...............

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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: XU, JUN	FACILITY NUMBER: 414002549
	VISIT DATE: 07/10/2019

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LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee's daughter. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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