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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415394
Report Date: 02/10/2021
Date Signed: 02/10/2021 02:34:31 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:GAO, LING & MENG, QING YIFACILITY NUMBER:
434415394
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/10/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Qing Yi MengTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Oscar Huang conducted an announced case management tele-inspection via video conference call (FaceTime) with Qing Yi Meng, Licensee. The purpose of today's tele-inspection is to conduct an inspection in response to licensee's increase request and a change from co-licensees to a single licensee. Licensee rents the home. LPA observed six children (two infants & 4 preschoolers) & an adult assistant at home. Days and hours of operation are Monday to Friday, 8:00am to 6:00pm. The adults that reside in the home are Licensee only. LPA advised licensee that her school-age daughter will be accounted to her capacity when present during the operation hours.

Licensee agreed to give LPA a tour of the indoor/outdoor area via FaceTime during today's tele-inspection. The entire home was inspected for health and safety hazards. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Temperature was measured at 70 degree F by thermostat on the wall. LPA observed no stairs inside the home. The main area of the home is used for the day care are living room, master bedroom and bathroom #1. Off limit areas inside the home: all other 3 bedrooms, master bathroom, kitchen, and garage. LPA observed a fully charged 2A10BC fire extinguisher, 1 functioning carbon dioxide detector, at least 1 working smoke detector, fenced backyard, and no bodies of water. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee stated that there are no weapons or pets in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee has child care liability insurance under United States Liability Insurance Company.



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 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.

LPA observed Licensee & her helper have current CPR and First Aid certification expiring 04/2021 & 10/2021 respectively. Licensee requested to be exempted from mandated reporter training due to her limited English. LPA observed appropriate records for immunization against measles, pertussis, and an opted out influenza statement for Licensee & her helper, and were on file.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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: GAO, LING & MENG, QING YI
FACILITY NUMBER: 434415394
VISIT DATE: 02/10/2021
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Supervision of children was discussed with Licensee, and she understands that they 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 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 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. Incidental Medical Services (IMS) were discussed with Licensee. Licensee is not providing IMS at this time. If in the future any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

LPA advised Applicant that 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 reviewed safe sleep policies for the infants with the Applicant and provided "A Child Care Provider's Guide to Safe Sleep & Individual Infant Sleeping Plan (LIC 9227) and included the recent released PIN 20-24-CCP. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing.

LPA reviewed COVID-19 infection prevention guidance & self-assessment with licensee including her plans in place to protect and support staff, children, cleaning & hygiene implementation, health screening & social distancing practices, meal times and arrival & pickup procedures. LPA observed posters & visitor policy notice were posted at the front entrance.



A fire clearance approval from the Sunnyvale Fire Department was granted on 01/25/2021: Fire clearance granted. The living room, master bedroom, backyard and side outdoor walkway are the only areas in use.

The licensee was informed that due to the current COVID-19 pandemic and "Stay at Home" Order, today's report (Facility Evaluation Report - LIC 809 &LIC809-C) will be emailed to the licensee's email address at qinghuafamilydaycare@gmail.com with "Read Receipt" notification. The licensee understands that her response to the email is considered an acknowledgement of "receipt" of today's report.

LPA conducted an exit interview with Licensee, and advised her that her large FCCH license is now pending upon the following item and the management approval:



1. Acknowledgement of "receipt" of today's report has been received by LPA Huang.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
LIC809 (FAS) - (06/04)
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