434416353-1-11-2022-07-CC-YHUG-CAKV99-20220111151359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416353
Report Date: 01/11/2022
Date Signed: 01/11/2022 03:14:59 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:	ZHOU, XIN		FACILITY NUMBER:	434416353
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	01/11/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Xin Zhou		TIME COMPLETED:	03:35 PM

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Licensing Program Analyst (LPA) Oscar Huang conducted an announced prelicensing inspection and met with Xin Zhou, Applicant for a small Family Child Care Home license. LPA observed applicant's husband & her preschooler. LPA reminded Applicant that her school-age & preschooler will be accounted for her capacity when present at home during her operation hours.

The adults that reside in the home is applicant only. Days and hours of operation will be Monday - Friday from 8:00 AM to 6:00 PM. Applicant has completed her Preventative Health and Safety Child Care Training which includes an hour of nutrition & lead poisoning prevention on 11/8/2020, and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 10/2022. Applicant own the home and a copy of pro is on file. LPA reminder Applicant if she did not purchase liability insurance, she will need to issue affidavit regarding liability insurance for her Family Child Care Home to the parent of child in care.

The Applicant agreed to give LPA a tour of the home both indoor/outdoor during today's tele-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, Kitchen, and Bathroom #1. LPA observed screen fireplaces. Off limit areas inside the home: all four bedrooms, master bathroom, and garadge. LPA observed at least one combined functioning smoke detector, a full charged 2A-10BC fire extinguisher. Off limits outdoor are two blocked side yards. LPA advised Applicant that whenever the climb structure is installed, softpad shall be placed on the ground around it to absorb falls. 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. LPA observed a hand gun & a shot gun stored in a locked safe box, and animation stored separately in another safe box in different location and no pets. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded Applicant that smoking, drop side cribs, and baby walkers, bouncers, excer-saucers, jumpers etc. are not allowed in Family Child Care Homes. Applicant was advised to keep temperature within 68-85 degrees.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

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: ZHOU, XIN	FACILITY NUMBER: 434416353
	VISIT DATE: 01/11/2022

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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. Applicant, Xin Zhou was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Applicant, Xin Zhou and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Applicant, Xin Zhou of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. 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. 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

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. Applicant has completed her training on 9/1/2021, and copies of the certifications are on file.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

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: ZHOU, XIN	FACILITY NUMBER: 434416353
	VISIT DATE: 01/11/2022

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Forms of discipline were discussed with Applicant, Xin Zhou. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA discussed SB 792 Immunization Requirement with Applicant, Xin Zhou. LPA observed appropriate records and physician notes for immunization against measles, pertussis, and influenza for Licensee in file.

LPA reviewed COVID-19 infection prevention guidance & self-assessment with Applicant including the plans in place to protect and to support staff &children, as well as essential protective equipment and supplies, cleaning & hygiene implementation, arrival procedures, health screening & social distancing practices and meal times.

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 conducted an exit interview and advised the Applicant, Xin Zhou that her small Family Child Care Home license is now pending on management approval.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

LIC809 (FAS) - (06/04)

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