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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414687
Report Date: 04/23/2019
Date Signed: 04/23/2019 02:34:57 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:XU, HUIMINFACILITY NUMBER:
434414687
ADMINISTRATOR:XU, HUIMINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 933-8057
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: 0DATE:
04/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Huimin XuTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee Huimin Xu for an unannounced annual/random inspection. LPA explained the nature of today’s inspection to Licensee. LPA observed licensee's mother and no school-age day care children in the home during today's inspection. Licensee stated she teaches art drawing for after school-age student. Days and hours of operation are Monday to Friday, 3:30am to 5:00pm. The adults that reside in the home are Licensee and her husband. Her 7 years old daughter also lives in home. LPA advised licensee her daughter will be accounted to her capacity when presented in home during working hour.

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, Licensee was advised to keep temperature within 68-85 degrees. LPA observed no stairs inside the home. The main area of the home is used for the day care is the converted garage with city permit, where it includes a bathroom and a bar place. All other areas in the home are off-limit: kitchen, living room, master bedroom, 2 other bedrooms, and a bathroom. LPA observed a barricaded fireplace. LPA observed safe and sufficient materials, and 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. LPA observed a fenced backyard and no bodies of water. LPA observed two locked storage sheds in the fenced off area. Off limit areas outside the home: All the backyards.
Facility Evaluation Report dated 04/23/2019 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
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: XU, HUIMIN
FACILITY NUMBER: 434414687
VISIT DATE: 04/23/2019
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Facility Evaluation Report dated 04/23/2019 to be continued from previous page:
Licensee owns the house, but carry no child care liability insurance. LPA observed parents signed Affidavit Regarding Liability Insurance For Family Child Care Home forms and kept in each child file. LPA observed Licensee has current CPR and First Aid certification expiring 09/2019. LPA observed a current roster of the children and a fire and disaster drills log which is to be done at least once every six months. The last drills were conducted on 11/08/2018. LPA reviewed 8 random children files that are required by the regulations including Identification & Emergency information & 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. LPA provided Licensee with the ratio/capacity chart for her reference. 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 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 immunization against measles, pertussis, and influenza for Licensee 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/training/childcare.htm. Licensee had completed her training and the certification was in file. Licensing Forms, Title 22 Regulations, Resources & Information, Quarterly Updates, Videos can be obtained through the internet at http://www.ccld.ca.gov.
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 KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
LIC809 (FAS) - (06/04)
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