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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415687
Report Date: 08/16/2021
Date Signed: 08/16/2021 12:20:52 PM

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:HUANG, XUECONGFACILITY NUMBER:
434415687
ADMINISTRATOR:HUANG, XUECONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 627-6848
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:14CENSUS: 12DATE:
08/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Xuecong HuangTIME COMPLETED:
12:30 PM
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On 08/16/2021 at 10:21am, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee, Xuecong Huang, for the purposes of conducting a Required 1 Year Inspection. Present for this inspection are the Licensee, two fingerprint cleared and associated assistants, and twelve children in care (one infant and eleven preschool age). The facility was toured to conduct a health and safety inspection.

The home is a 1-story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living/dining room combo, master bedroom, master bathroom, and backyard. The OFF LIMIT AREAS are the laundry room, garage, bedrooms 2-4, kitchen, and half bathroom, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision. The ISOLATION AREA will be the dining room near the dining table.

The interior of the home was toured at 10:22am. There are toys and learning materials in the facility. All hazardous materials, cleaning compounds, detergents, and toxins were observed to be made inaccessible to children during today's inspection. Furniture and equipment accessible to children were observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Per Licensee, there are no firearms kept in the home. There is a fireplace in the home which is barricaded to prevent access to children. The backyard was toured at 10:35am. The backyard is fenced. All play equipment is operable and age-appropriate. Areas around swings, slides, and high climbing equipment have cushioning material to absorb falls. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during today's inspection. There is a fountain in the backyard which LPA observed to be filled with rocks to prevent water accumulation.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HUANG, XUECONG
FACILITY NUMBER: 434415687
VISIT DATE: 08/16/2021
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The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee is operating under CPR/1st Aid blanket waiver and has signed attestation form. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. 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.”

Licensee was 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 that California Law requires licensed 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. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
LIC809 (FAS) - (06/04)
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