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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416219
Report Date: 11/26/2019
Date Signed: 11/26/2019 12:21:43 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:ZHANG, LUFACILITY NUMBER:
434416219
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
11/26/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Lu ZhangTIME COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee Lu 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 two day care infants. Days and hours of operation are Monday to Friday, 8:30 a.m. to 6:30 p.m. The adults that reside in the home are Licensee and her husband. Licensee stated that she will have two tenants who had fingerprint clearances to move-in on the beginning of next year, both of them are currently out of country. LPA advised licensee to submit both tenants criminal record statement & statement and proofs of TB immunization was taken within 12 months.

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 except that although the adult assistant has the background check clearance but was not associated with the facility. 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. 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, dinning room, family room, and bathroom #1. LPA observed two screened fireplaces. Off limit areas inside the home: kitchen, all four bedrooms, bathroom #2, heater closet, and garage. Off Limit areas outdoor: back portion of backyard, and two side yards. LPA observed a fully charged 3A40BC fire extinguisher, one functioning carbon dioxide detectors, at least two 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 reminded licensee that smoking, drop side cribs, and baby walkers, bouncers, excer-saucers, jumpers etc. are not allowed in Family Child Care Homes. Temperature was measured at 72 degree. Licensee was advised to keep temperature within 68-85 degrees. Licensee rent the house with liability insurance was under DCI.
Facility Evaluation Report dated 11/26/2019 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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, LU
FACILITY NUMBER: 434416219
VISIT DATE: 11/26/2019
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Facility Evaluation Report dated 11/26/2019 to be continued from previous page:
LPA observed Licensee has current CPR and First Aid certification expiring 12/2019. LPA observed a current roster of the children. The last drills were conducted on 11/14/2019. LPA reviewed 2 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.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records for immunizations against measles, pertussis, and influenza for Licensee. 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.

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. LPA provided Licensee with the ratio/capacity chart for her reference.

LPA reviewed safe sleep policies for the infants with the Applicant and provided "A Child Care Provider's Guide to Safe Sleep. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing. A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Applicant. Department website: www. ccld.ca.gov provided to Applicant. LPA also discussed with applicant regarding infant equipment accessory recalls.

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: https://mandatedreporterca.com/. Licensee completed her training on 07/17/2019, and her certification was on file.



A fire clearance was granted for capacity of 14 (Large FCCH) from the Santa Clara Fire Department was received on 11/18/2019.

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 KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
LIC809 (FAS) - (06/04)
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