434417008-10-14-2021-07-CC-FCJO-C7SP2R-20211014105621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417008
Report Date: 10/14/2021
Date Signed: 10/14/2021 10:56:28 AM

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:	CHENG, ANGELA		FACILITY NUMBER:	434417008
ADMINISTRATOR:	ANGELA CHENG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 701-7222
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 0	DATE:	10/14/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Angela Cheng		TIME COMPLETED:	11:00 AM

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) Fermin Campos-Jaramillo conducted an announced pre-licensing inspection to the home today. LPA met with Angela Cheng, applicant, and explained the nature of today's inspection to her. Applicant was previously licensed at 950 Redwood Ave, Sunnyvale, CA 94086. The adults that reside in the home are the applicant, and her spouse Timothy. Also in the home reside applicant's two minor children. Days and hours of operation will be Monday to Friday from 9:00 AM to 6:00 PM. Applicant understands that the children cannot stay in the home for more than 24 continue hours. Applicant has completed her Preventative Health and Safety Child Care Training on 4/15/18 and the update on lead poisoning on 9/28/21. Applicant's pediatric CPR and First Aid certifications are current and will expire on 9/11/23. Applicant rents the home and a copy of the rental lease is in file. Applicant states does not have liability insurance for a family child care home (FCCH) and will use the Affidavit regarding liability insurance for Childcare (form LIC 282). LPA toured the indoor and outdoor areas of the one story home during today's inspection. LPA observed there are not wall heaters in the home. Off limit areas inside the home: Two bedrooms, private living room and kitchen, and the attached garage. LPA observed applicant has a 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has at least one working carbon monoxide detector. Off limits outdoor areas are: The right side yard. LPA observed there are not bodies of water. Applicant's will use the front and back yards as playground for the children in care. LPA observed the back and front yards are fenced. Applicant states that there are no weapons in the home. Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children. LPA observed the home has a barricaded fireplace located in the on limits area. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. A review of staff records on 10/12/21 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions, and are associated to the applicant's prior license # 434415419. ******************* Report dated 10/14/21 continues in page 2 *************

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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: CHENG, ANGELA	FACILITY NUMBER: 434417008
	VISIT DATE: 10/14/2021

NARRATIVE

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Report dated 10/14/21 continues from page 1.
LPA reminded Applicant 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.
Forms of discipline applicant will use: Communication with children and redirection. 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. Applicant understands her minor children count as part of the capacity of her license until they reach the age of ten years old.
Department website: www. ccld.ca.gov provided to applicant.
LPA discussed the requirements of AB 633 with the applicant. LPA also discussed "zero tolerance" related regulations with the applicant.
LPA observed proof of immunization for measles, pertussis and influenza are in file for applicant.
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: http://www.ada.gov/childqanda.htm. Applicant and her husband have completed the required "mandated reporter" training AB1207 both on 6/16/21 and applicant understands the training is mandatory for all the adults in contact with children, and to be renewed every two years. LPA referred the applicant to the training website: www.manatedreporterca.com for additional information on the online training.
LPA advised the applicant of the new regulations on Safe sleep for infant children. and provided applicant with form LIC9227. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. A fire clearance was granted by the Sunnyvale Department of Public Safety on 9/30/21.
LPA conducted an exit interview with the applicant and advised her that a large FCCH license will be approved pending on the following: 1) Approval from a manager of the Licensing Department.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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