434414516-10-17-2019-07-CC-YHUG-BH2VAM-20191017161609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414516
Report Date: 10/17/2019
Date Signed: 10/17/2019 04:16:13 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:	MA, FENGJUN		FACILITY NUMBER:	434414516
ADMINISTRATOR:	MA, FENGJUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 557-2307
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	14	CENSUS: 12	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Fengjun Ma		TIME COMPLETED:	04:30 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 Fengjun Ma for an unannounced annual/random inspection. LPA explained the nature of today’s inspection to Licensee. Present were licensee's mother, two adult assistants, one infant, and 10 preschool children and her own school age son 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, her husband, and her mother. 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 appears clean and orderly, with heating and ventilation for safety and comfort of the children. Temperature was measured at 72 degree F by thermostat on the wall. LPA observed no baby walker on the premises. LPA observed no stairs inside the home. The main area of the home is used for the day care are living room, dinning room, bedroom #4 and bathroom #1. LPA observed a barricaded fireplace. 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 3A40BC fire extinguisher, at least a working smoke detectors, and a functioning carbon monoxide detectors. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: bedroom #1, #2, & #3, bathroom #2, kitchen, and garage. LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: both side yards. Licensee rents the house, and has child care liability insurance with DCI. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Facility Evaluation Report dated 10/17/2019 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: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: MA, FENGJUN	FACILITY NUMBER: 434414516
	VISIT DATE: 10/17/2019

NARRATIVE

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Facility Evaluation Report dated 10/17/2019 to be continued from previous page:
LPA observed Licensee and her mother have current CPR and First Aid certification expiring 07/2020. LPA observed a current roster of the children. The last drills were conducted on 10/15/2019. LPA reviewed 11 children files that are required by Title 22 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 mother, and her assistants 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: https://mandatedreporterca.com/ , LPA observed licensee, and two assistants had completed their training on 01/06/2019, and have the certifications on file.
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: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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