434416084-11-14-2019-07-CC-YHUG-BHX28G-20191114161018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416084
Report Date: 11/14/2019
Date Signed: 11/14/2019 04:10:26 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:	ZHANG, XIUHONG		FACILITY NUMBER:	434416084
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	11/14/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Xiuhong Zhang		TIME COMPLETED:	04:20 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 Licensee Xiuhong Zhang for an unannounced Case Management inspection in response to licensee's increase capacity request. LPA explained the nature of today’s inspection to Licensee. Present were a finger print clearance assistant, Zhiping Zhao, a parent of daycare child who was at the facility to celebrate her son's birthday, and four day care children( two infants & two preschool children), they are the same children as last visit on 08/06/2019. Days and hours of operation are Monday to Monday, 8:00 a.m. to 6:30 p.m. The adults that reside in the home are Licensee only. 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 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 toured the indoor and outdoor areas during today's inspection. LPA toured the indoor and outdoor areas during today's inspection. The entire home was inspected for health and safety hazards. LPA observed no stairs inside the home. The main area of the home is used for the day care are living room, kitchen, bedroom #2 & #3 and bathroom #2. LPA observed a blocked fireplace. Off limit areas inside the home: kitchen, bedroom #1 & #4, bathroom #1, and garage. LPA observed a fully charged 2A40BC fire extinguisher, one functioning carbon dioxide detectors, one working smoke detectors, fenced backyard, and no bodies of water. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Applicant states that there are no weapons or pets in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA does not observed smoking, drop side cribs, and baby walkers, bouncers, excer-saucers, jumpers etc. in Family Child Care Homes. LPA observed room temperature at 70 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. Licensee rents the house, and has child care liability insurance under DCI. Facility Evaluation Report dated 11/14/2019 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: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

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: ZHANG, XIUHONG	FACILITY NUMBER: 434416084
	VISIT DATE: 11/14/2019

NARRATIVE

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Facility Evaluation Report dated 11/14/2019 to be continued from previous page:
LPA observed Licensee and her assistant have current CPR and First Aid certification expiring 06/2020 & 02/2021 LPA observed a current roster of the children. The last drills were conducted on 06/10/2019. LPA reviewed four children files that are required by the regulations 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 Licensee, and she understands that she 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 she does not transport children via vehicle but she understands 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. LPA also discussed with licensee regarding Fisher-Price Infant equipment accessary recall, and make sure the facility does not use the items.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records for immunizations against measles, pertussis, and influenza for Licensee and her assistant in file. Incidental Medical Services (IMS) were discussed with Licensee. Licensee 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.

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: http://www.mandatedreporterca.com/, Licensee & her assistant had completed their training on July 24, 2018 & August 14, 2019, and their certification were kept on their files.

A fire clearance approval from the San Jose Fire Department was granted on 11/12/2019. Rooms accessible to children include: Bedrooms #2 & #3, Bathroom #2, Living room, Kitchen, Outside Playground (sun roof).
Rooms Off limits to children include: bedrooms #1& #4, Bathroom #1, and Garage.

No Deficiency was cited. Exit interview conducted with Licensee and advised her that a large Family Child Care Home license is now pending upon the management approval.

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: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

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