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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415225
Report Date: 08/03/2021
Date Signed: 08/03/2021 10:53:44 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LIU, CUIHONGFACILITY NUMBER:
434415225
ADMINISTRATOR:LIU, CUIHONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 857-9063
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:14CENSUS: DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Cuihong LiuTIME COMPLETED:
11:00 AM
NARRATIVE
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On Tuesday, August 3, 2021 8:49 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with the Licensee Cuihong Liu. The Licensee speaks Mandarin and a Mandarin Interpreter requested. LPA called the Language Link Line and requested for a Mandarin Interpreter. Present on this visit were the Licensee's spouse, Licensee's Assistant and 8 preschool children, 2 school age and 3 infants. Licensee stated that the home operates from Monday to Friday from 8:30 am to 6pm.

LPA toured the home to conduct a Health and Safety Inspection. The On Limit areas of the home are the living room, play room, bedroom #1 (used for napping infants), dining area and hallway bathroom and the backyard. The Off Limit areas are the bedroom #2 & 3, bedroom 1 bathroom, kitchen, the front yard, side yards, and the garage. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Temperature was measured at 69 degree F by thermostat on the wall, Licensee was advised to keep temperature within 68-85 degrees. LPA observed no stairs inside the home, there were gates separating the kitchen and dining room, gates separating the main door and the living room and gates separating the back yard and the side yard. LPA observed a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector. The fireplace is screened. LPA observed a fenced backyard and no bodies of water. LPA observed two locked storage sheds in the backyard. Licensee stated that there are no firearms and weapons in the home. LPA observed no pets in the home. Cleaning Products, toxic agents, medications, and sharp objects were stored in kitchen top cabinets inaccessible to children. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. LPA observed 2 cribs in the bedroom # 1.

SEE 809 C....
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIU, CUIHONG
FACILITY NUMBER: 434415225
VISIT DATE: 08/03/2021
NARRATIVE
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Continuation......

Licensee rents the house, does have child care liability insurance. Completed Affidavit Regarding Liability Insurance were reviewed in each child's file. LPA advised that since Licensee carries child care liability insurance, there is no need to complete the LIC 282. LPA observed Licensee has current CPR and First Aid certification expiring 03/2022. AB1207 was taken on 02/14/2021. LPA observed a current roster of the children and a fire and disaster drills log were conducted monthly. The last drills were conducted on 07/21/2021. LPA observed a pull down fire alarm located on the living room wall. Facility roster of children was reviewed, and a copy was obtained. LPA reviewed 6 children files. LPA observed all required children records on file including Immunization records are maintained and up-to-date, LIC 9150, and Notification of Parents’ Rights is in each child’s file.

Individual Medical Services (IMS) policy was discussed. 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: https://www.ada.gov/childqanda.htm.

Licensee is reminded that all assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. To file a complaint regarding a state licensed community care facility or child care facility, call Community Care Licensing Division Complaint Hotline 1-844-538-8766 or email letusno@dss.ca.gov.

Licensee is encouraged to visit the Department’s website to access resources for Providers, Title 22 Regulations, online option to pay Annual License fee, all forms can be downloaded, Child Care Resource & Referral Network (R&Rs) and more information at https://cdss.ca.gov/inforesources/child-care-licensing. This website link https://ccld.childcarevideos.org/ includes videos that explain licensing topics relevant to families and licensed child care providers.



SEE 809 C.......
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIU, CUIHONG
FACILITY NUMBER: 434415225
VISIT DATE: 08/03/2021
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Conitnuation...

LPA Estoesta discussed, provided copies of New Safe Sleep Brochure, Lead Poisoning Facts Flyer and California Child Safety Seat Law to the licensee. For more information, please follow the links https://cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, https://cdss.ca.gov/inforesources/child-care-licensing/water-testing-information and https://www.chp.ca.gov/Programs-Services/Programs/Child-Safety-Seats.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

For licensing updates, advised Licensee to email childcareadvocatesprogram@dss.ca.gov and request to be added to the email list. There are no deficiencies cited on this visit. This report shall remain on file for 3 years. A copy of the appeal rights was provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3