<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403110
Report Date: 01/30/2020
Date Signed: 01/30/2020 12:52:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WANG, SHU-CHIFACILITY NUMBER:
434403110
ADMINISTRATOR:WANG, SHU-CHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 968-3382
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:14CENSUS: 10DATE:
01/30/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:LicenseeTIME COMPLETED:
12:55 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
I, Licensing Program Analyst (LPA), James Sampair, made a Case Management - Annual Continuation inspection to the facility that began at 10:35 am. The Licensee, Shu-Chi Wang, was present at the time of the inspection, as was her husband, Morgan Yang, and 1 employee: Angie Chang. Also living at her home is her daughter, Deboran Yang. Under care at the time of the inspection were a total of 10 children: 0 infants and 10 preschoolers. All of the adults meet the criminal background clearance requirement. The main home is totally off-limits and the on-limit areas are the classroom and the bathroom in the guest house, as well as the back yard.

The facilities had working smoke detectors, carbon monoxide detectors, and a fully charged size 2A10BC fire extinguisher.

There were no bodies of water. The school room was kept clean and orderly, with heating and ventilation for safety and comfort, as well as safe toys, play equipment, and materials. The Licensee ensured that children are supervised at all times by the Licensee. The Licensee maintains the capacity on the license. Each child has safe, comfortable, and healthy accommodations, furnishings, and equipment. The Licensee had current pediatric CPR and first aid, as well as mandated reporter training. Licensee stated that there were no guns or weapons in the home. Licensee has 0 pets. At 11:45 am, 2 employees and 5 children's files were reviewed and found to be complete with immunization records.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WANG, SHU-CHI
FACILITY NUMBER: 434403110
VISIT DATE: 01/30/2020
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
26
27
28
29
30
31
32
Licensee owns the facility. The Licensee is utilizing the child care roster. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint-cleared prior to being in the presence of children or an immediate civil penalty can be assessed. Also discussed were documents to be provided to parents and legal guardians, including the brochure on Lead Poisoning. Individual Medical Services (IMS) policy was discussed. 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 (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. The Licensee registered her email address at childcareadvocatesprogram@dss.ca.gov for all new licensing updates.

There were no deficiencies cited in today's visit. An exit interview was conducted with the Licensee. Appeal rights were given to the Licensee.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2