434414240-10-24-2019-07-CC-DMAC-BH9QE2-20191024120536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414240
Report Date: 10/24/2019
Date Signed: 10/24/2019 12:05:50 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:	LIU, LI		FACILITY NUMBER:	434414240
ADMINISTRATOR:	LIU, LI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 757-4723
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 11	DATE:	10/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Li Liu		TIME COMPLETED:	12:15 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 Analysts (LPAs) Tuoc Doan and Dung Mac met with Li Liu, the Licensee for an unannounced annual inspection visit. Present were two Assistant Providers Nan Xia and Enzhen Zhao, and 11 day care children, of whom two were infant age. Days and hours of operation are: Monday-Friday 8:00am-6:00pm. LPAs toured the home both inside and out. Off-limit areas inside the home are master bathroom and garage. Licensee is using the 3 bedrooms for infants to nap. LPAs did not observe bodies of water. Licensee states that there are no weapons in the home. Detergents, cleaning products, medications, hazardous and other toxic materials are inaccessible to children. LPAs observed a fully charged fire extinguisher. Smoke and Carbon Monoxide detectors were tested and proved to be functioning. The home is clean, orderly, and safe for the day care children. LPAs observed sufficient materials, toys, and play equipment for the day care children. Supervision of children was discussed with Licensee and she understands that she must be present in the home during the day care hours and ensures that children are supervised. Licensee stated that she does not transport children and that currently she does not have any children in care who requires administration of medication. LPAs reviewed the Child Care Facility Roster. The last fire/disaster drill was conducted on 05/12/19. 11 children's files were reviewed and the files are determined to be complete. Licensee and Assistant Providers' file were reviewed. They maintain records of Tuberculosis clearance, Measles and Pertussis immunization, and required training. Licensee's Mandated Report training expires 9/29/20 and her Pediatric CPR & First Aid certification expires 8/26/20. LPAs reminded Licensee that the Mandated Reporter Training needs to be renewed every two years.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

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: LIU, LI	FACILITY NUMBER: 434414240
	VISIT DATE: 10/24/2019

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A review of records on 10/24/19 shows that all staff and other adults who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Adults who reside in the home are Licensee, and Licensee's Spouse. They have Clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. LPAs 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Facility's Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires IMS. 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.

Beginning January 1, 2019 Assembly Bill 2370 requires that all licensed homes to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” and Safe Sleep Information to Licensee.

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection. LPAs conducted an exit interview where this report was reviewed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

LIC809 (FAS) - (06/04)

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