434414749-6-29-2021-07-CC-YHUG-C4FR45-20210629124054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414749
Report Date: 06/29/2021
Date Signed: 06/29/2021 12:41:44 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:	HU, XIANGQIN		FACILITY NUMBER:	434414749
ADMINISTRATOR:	HU, XIANGQIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 207-8307
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95054
CAPACITY:	14	CENSUS: 9	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Wan Siu Siao		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Oscar Huang met with assistants, Wan Siu Siao & Zhiyi Mou for an unannounced required annual inspection. According to the assistants that Licensee was out of country for emergency matter. LPA explained the nature of today’s inspection to them. LPA 9 day care children (3 infants, 6 preschoolers) in the home during today's inspection. Days and hours of operation are Monday to Friday, 8:00 a.m. to 6:00 p.m. The adults that reside in the home is licensee only. Family Child Care Home Key Indicator Tool (KIT) #1 was used for the inspection. 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 Licensees 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, Licensees 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 kitchen, dinning room, living room, bedroom #1, and a bathroom #1. LPA observed no 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, a working smoke detector, and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: master bedroom, bedroom #2, bathroom #2, and the garage. LPA observed a fenced backyard and no bodies of water. Off limit areas outside the home: both side yards and right side of the backyards. Licensee rents the house, and has child care liability insurance under DCI. Facility Evaluation Report dated 06/29/2021 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: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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: HU, XIANGQIN	FACILITY NUMBER: 434414749
	VISIT DATE: 06/29/2021

NARRATIVE

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Facility Evaluation Report dated 06/29/2021 to be continued from previous page:
LPA observed both assistants have current CPR and First Aid certifications expiring 04/2023. LPA observed a current roster of the children. The last drills were conducted on 06/15/2021. LPA reviewed all 9 children files mandated by the regulation 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 assistants, and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. They understand their capacity options. They state that they do not transport children via vehicle but they understand that children cannot be left in parked vehicles unattended at any time. LPA reviewed safe sleep policies for the infants with them including "A Child Care Provider's Guide to Safe Sleep” document as well as the most recent PIN 20-24-CCP for Infant SafeSleep and the requirement for checking and logging during the nap in every 15 minutes, including LIC 9227 for infants under one year old. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing. LPA observed nap records for all infants under 2 years old, and safe sleep plan for an infant under one year old.

LPA discussed AB 2231: Civil Penalty Updates effective July 1, 2017 with assistants. 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 assistants. LPA observed appropriate records for immunizations against measles, pertussis, and influenza for them in file. Incidental Medical Services (IMS) were discussed with them. The facility 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/ . Both helpers requested to be exempted from training due to English is not their primary language.

No Deficiency was cited. Exit interview conducted with Assistant Wan. 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: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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