434412837-5-22-2019-07-CC-YHUG-BCEQH7-20190522121036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412837
Report Date: 05/22/2019
Date Signed: 05/22/2019 12:11:39 PM

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:	LUN, XIAOQING		FACILITY NUMBER:	434412837
ADMINISTRATOR:	LUN, XIAOQING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 898-4407
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	14	CENSUS: 10	DATE:	05/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Xiaoqing Lun		TIME COMPLETED:	12:25 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) Oscar Huang met with Licensee, XiaoQing Lun for an unannounced annual/random inspection. LPA explained the nature of today’s inspection to Licensee. LPA also observed two adult assistants and 10 day care children (2 infants and 8 preschoolers) in the home during today's inspection. Days and hours of operation are Monday to Friday, 8:30am to 6:30pm. The adults that reside in the home are Licensee and two tenants. A review of staff records on today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also 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 understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, Licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed no stairs inside the home. The main area of the home are used for living room, dinning room, one bedroom, and one bathroom. LPA observed a steel screen wall heater. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored inaccessible to children. LPA observed a fully charged 2A10BC fire extinguisher, a working smoke detector, and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: the two bedrooms, a bathroom, kitchen and the garage. LPA observed a fenced backyard and no bodies of water. LPA observed a locked storage shed in the fenced off area. Off limit areas outside the home: fenced right yard. Temperature was measured at 70 degree F by thermostat on the wall, Licensee was advised to keep temperature within 68-85 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Facility Evaluation Report dated 05/22/2019 to be continued on next page:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019

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

FACILITY NAME: LUN, XIAOQING	FACILITY NUMBER: 434412837
	VISIT DATE: 05/22/2019

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

Facility Evaluation Report dated 05/22/2019 to be continued from previous page:
Licensee rents the house. Licensee does not carry child care liability insurance, LPA observed Affidavit Regarding Liability Insurance For Family Child Care Home forms were signed by the parents and kept in each of the child's file. LPA observed Licensee has current CPR and First Aid certification expiring 10/2019. LPA observed an incomplete current roster of the children. The last drills were conducted on 04/26/2019. LPA reviewed 10 children files that are required by the regulations including Immunization records are maintained and up-to-date and Notification of Parents’ Rights is in each child’s file.

Supervision of children was discussed with Licensee, and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. Licensee states that she does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time. LPA reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing. LPA discussed AB 2231: Civil Penalty Updates effective July 1, 2017 with Licensee. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. A $100 per day for each violation for Failure to Correct, and $250 immediately and $100 per day per violation until corrected for Repeat Violations.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records for immunizations against measles, pertussis, and influenza for Licensee & her helpers in file. Incidental Medical Services (IMS) were discussed with Licensee. Licensee 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.htmLicensee will submit a plan of operation for IMS if in the future they provide any IMS to a child in care.

LPA discussed Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training web site is available at: http://www.mandatedreporterca.com/ , Licensee requested that she and her helpers to be exempted from training until a Chinese version becomes available.
No Deficiency was cited. Exit interview conducted with Licensee. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2