434403110-6-21-2021-52-CC-JSAR-C47R6V-20210621124523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434403110
Report Date: 06/21/2021
Date Signed: 06/21/2021 12:45:38 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-CHI		FACILITY NUMBER:	434403110
ADMINISTRATOR:	WANG, SHU-CHI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 968-3382
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94024
CAPACITY:	14	CENSUS: 0	DATE:	06/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Shu-Chi Wang and Morgan Yang		TIME COMPLETED:	01:22 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) James Sampair conducted an unannounced random annual site inspection of this facility at 10:00AM. At arrival, LPA met with Licensee Shu-Chi Wang and her husband Morgan Yang. Ms. Wang and Mr. Yang directed a tour for LPA Sampair through all areas of the facility inside and outside. Present at the facility were 0 children in care and 0 assistants, because they have not been conducting in-person care since the beginning of the Covid-19 pandemic in March 2020. Instead, with the 11 children on their roster, they have been providing 1 to 2 hours a day of instruction and interaction with the children via Zoom. All of the staff present are background cleared and associated with this facility. The facility is currently being rewired, so the operations have been suspended completely at the facility until further notice. Per Mr. Yang, there are no firearms present or stored on the premises. 2 children's files were reviewed and they were complete. 2 staff records were reviewed and they were complete. The Licensee has current CPR/First Aid certification. All required postings were present.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WANG, SHU-CHI	FACILITY NUMBER: 434403110
	VISIT DATE: 06/21/2021

NARRATIVE

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This facility provides Individual Medical Services (IMS). LPA reviewed storage of medication, equipment, and supplies, and they were found to be handled in accordance with regulations. For IMS information, see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information was provided: US Department of Justice (USDOJ) toll-free Americans with Disabilities Act (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: http://www.ada.gov/childqanda.htm.

Facility Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Facility administrator was provided with CDSS Effects of Lead Exposure Informational and lead testing requirements were discussed.

No deficiency cited during today’s visit. The appeals rights and a notice of site visit were provided that is to be posted for 30 days. A copy of this report was provided and is to be kept in the facility records for a period of three years.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC809 (FAS) - (06/04)

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