434412802-10-10-2019-07-CC-SCOS-BGTW2D-20191010165410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412802
Report Date: 10/08/2019
Date Signed: 10/10/2019 04:54:14 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:	YAN, MIN		FACILITY NUMBER:	434412802
ADMINISTRATOR:	YAN, MIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 228-7482
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	14	CENSUS: 9	DATE:	10/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	YAN MIN		TIME COMPLETED:	02:00 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	On October 08 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual inspection of Family Community Care Home of licensee Min Yan and explained the purpose of today's inspection. Present in the home were #9 children in care and her assistant (husband) Bo Luo. Days and hours of operation are Monday through Friday from 8:00 AM –6:30 PM. Licensee understands the capacity options and understands that the maximum capacity is 14 children. There are two adults residing in the home; Licensee and Licensee’s Husband (Bo Luo) . A review of staff records on (10/08/2019 shows that all listed individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period. Licensee's Pediatric CPR and First Aid expires on 12/20/20 LPA observed Licensee and husband have proof of immunity against Measles and Pertussis per Immigration Green Card and Tuberculosis clearance. Licensee and husband have proof of AB1207 Mandated Reporter Training Certificate expires 01/2021. LPA reviewed the roster of children in care and a copy was obtained. LPA reviewed a sample of 4 children's files. Records review include Parents' Rights, immunization, Emergency Contact Information, and Consent for Emergency Medical Treatment form. Family Child Care Home Notification of Parents' Rights forms (LIC 995A), Emergency Contact Information, and Consent for Emergency Medical Treatment form.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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: YAN, MIN	FACILITY NUMBER: 434412802
	VISIT DATE: 10/08/2019

NARRATIVE

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LPA inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPA observed a fully charged ABC 2-A-10 BC fire extinguisher Fire and disaster drills were last conducted and recorded on 08/6/19. Per Licensee the Fire Inspector inspected the home in early October and approved alterations, due to Licensee altering the original facility. Off limit areas in home are as follows: Kitchen (LPA observed movable barricade at the entrance of kitchen to prevent children from accessing it) the Garage, bedrooms 1 W/bath, bedroom 2 and 3 are off limits. Bedroom two’s wall has been taken down allowing the room to open up into the living room. These alterations to the facility were addressed during the previous inspection. Confirmation of approval from fire inspector is pending. LPA observed a fully fenced back yard and is used for outdoor activities. No bodies of water were observed

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. Licensee states that there are no weapons in the home.

Licensee states that currently she is not providing Incidental Medical Services. 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. .

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Exit Interview was conducted, where this report was discussed and reviewed with Licensee. A copy of this report was given to Licensee.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

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