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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415104
Report Date: 08/23/2019
Date Signed: 08/23/2019 12:42:43 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:OUYANG, ANNFACILITY NUMBER:
434415104
ADMINISTRATOR:OUYANG, ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 893-2336
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:14CENSUS: 9DATE:
08/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Ann Ouyang TIME COMPLETED:
11:35 AM
NARRATIVE
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On August 23 , 2019 Licensing Program Analysts (LPA) Stephanie Collins conducted an annual random inspection of the home. LPA met with Licensee Ann Ouyang, and explained the purpose of today's inspection. Present in the home were the Licensee, her husband (Jerry Chan) and Assistant, Anping Ou.

There were 9 children present of whom 3 were of infant age. Days and hours of operation are Monday through Friday from 08:30 AM – 6:00 PM. Licensee understands the capacity options.

There are (2) two adults residing in the home; Licensee, the Licensee’s Husband (Jerry Chan) and their two children
A review of staff records on August 22, 2019 shows that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA 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.

LPA inspected the indoor and outdoor areas of the home today. Smoke and Carbon monoxide detectors were tested and proved to be functioning. LPA observed a fully charged 2A10BC fire extinguisher. Off limit areas in the home include the garage,kitchen,family-room and entire upstairs area. LPA observed child safety gates installed at the base of the staircases to prevent children from accessing the stairs. The backyard is fenced and is used for outdoor activities, off limit areas the gated dog area, side yard and two locked sheds ,
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
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 3
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: OUYANG, ANN
FACILITY NUMBER: 434415104
VISIT DATE: 08/23/2019
NARRATIVE
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Medication, cleaning products and similar items that can pose a danger to children if readily accessible are stored inaccessible to children. LPA reviewed the facility's roster and obtained a copy. Fire and disaster drills were last conducted and recorded on 6/1/19. Licensee states that there are no weapons in the home. Licensee has one small sized pet dog that is inaccessible to the day care children.

Licensee’s Pediatric CPR and First Aid expires on 05/20/20. LPA observed Licensee and her assistant have proof of immunity against Measles and Pertussis. Licensee as proof AB1207 Mandated Reporter Training Certificate.

LPA reviewed 9 children’s files. Records reviewed include Parents' Rights, immunization, Identification and Emergency Information, and Consent for Emergency Medical Treatment, Family Child Care Home Notification of Parents' Rights, and Affidavit Regarding Liability Insurance.

Licensee states that currently she is not providing Incidental Medical Services. 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.htm. .

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Safe sleep information was reviewed with Licensee.

LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

Regulatory violations were observed during the inspection visit. Therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were discussed and reviewed with Licensee. A copy of this report was given to Licensee.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: OUYANG, ANN
FACILITY NUMBER: 434415104
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited

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MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...].
This requirement is not met as evidenced by:
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LPA' review of staff files Assistant Anping Ou, does not have proof of AB1207 Mandated Reporter Training. Licensee stated that she has not completed the Mandated Reporter Training at this time.

This poses a potential risk to children's health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3