434410869-11-6-2019-07-CC-MMOO-BHNV6Z-20191106151023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410869
Report Date: 11/06/2019
Date Signed: 11/06/2019 03:10:27 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	OU, LIDAN		FACILITY NUMBER:	434410869
ADMINISTRATOR:	OU, LIDAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 366-2607
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	14	CENSUS: 12	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Lidan Ou		TIME COMPLETED:	03:20 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), Marilou Monico, made an unannounced annual required inspection. LPA met with Licensee, Lidan Ou, and explained the purpose of today's inspection. Also present in the home were licensee's adult helper and 12 daycare children including 1 infant and 11 preschool age. The daycare is open Monday to Friday from 8:30 AM to 6:30 PM. There are two adults living in the home: licensee and her husband. LPA toured the home both indoor and outdoor. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean. There is a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector, barricaded fireplaces, and no bodies of water. Off limit areas in the home include: 4 bedrooms, 2 bathrooms, and garage. Off limit areas outside the home: left side yard. Cleaning products, sharp objects, and other similar items are stored inaccessible to children. Per licensee, there are no weapons in the home. Licensee maintains a current children's roster and fire drill log. Licensee's CPR and First Aid are with an expiration date of March 2020. The home has a working telephone which is (408) 366-2607. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. (REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 11/06/19):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: OU, LIDAN	FACILITY NUMBER: 434410869
	VISIT DATE: 11/06/2019

NARRATIVE

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(CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 11/06/19):

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemption.

Incidental Medical Services (IMS) policy was discussed. Licensee states she is not providing IMS at this time. 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 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: http://www.ada.gov/childqanda.htm

As a result of this inspection, there were no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

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