435700316-5-27-2022-52-CC-CURE-CETRAS-20220527125135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700316
Report Date: 05/27/2022
Date Signed: 05/27/2022 12:51:54 PM

Document Has Been Signed on 05/27/2022 12:51 PM - It Cannot Be Edited

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:	GU, YUANYUAN		FACILITY NUMBER:	435700316
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 5	DATE:	05/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Yuanyuan Gu		TIME COMPLETED:	01:00 PM

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On 05/27/2022 at 10:45am Licensing Program Analyst (LPA) Christina Uribe, met with licensee Yuanyuan Gu for an UNANNOUNCED ANNUAL INSPECTION and for a case management visit for a capacity increase. Present for the inspection were 5 daycare children and 1 fingerprint cleared assistant, Katherine Orellana Diaz, and the licensee is within ratio today. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 9:00am-5:00pm.

The home is a single story home with 1 bedroom, 1 bathroom, living room, kitchen, detached garage and back yard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. All on/off-limit areas are consistent with the facility's pre-licensing reports.

The OFF-LIMIT AREAS are the laundry room, & garage and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the living room, bathroom, kitchen, bedroom, and backyard. The living room is the main daycare area and is also used as the isolation area in the corner if needed.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, carbon monoxide, telephone and fully stocked first aid kit. There is a hot tub in the backyard but there are no pools or any other bodies of water present at the time of the inspection. The hot tub is covered with an appropriately sized cover which is latched closed and can support the weight of an adult. Per licensee, there are no firearms or pets on the premises.

The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 04/04/2022. All required forms are posted and visible for public review.

Page 1 of 3 ***Continued on LIC809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GU, YUANYUAN	FACILITY NUMBER: 435700316
	VISIT DATE: 05/27/2022

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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 01/05/2024. The licensee is in compliance with the immunization laws and has completed the mandated reporter training on 12/13/2021. The assistant also has current and sufficient records for immunizations, CPR/First-Aid Certification, and records.

At 11:20am LPA Uribe reviewed 6 children’s files and personnel records. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. There is a current roster available for review and copy obtained. The facility does have liability insurance. Staff interview also conducted and documented.

Incidental Medical Services (IMS) policy was discussed and the facility does not have any children with the need for medication to be kept at the facility 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.

Application for Capacity Increase: All documents have been received for the increase of capacity application. The fire clearance for a capacity of 14 children was received from the Mountain View Fire Department on 05/05/2022. The licensee was reminded to abide by the conditions of the fire clearance which restricts the use of the garage and cellar to children in care. The licensee already has a hired and fingerprint cleared/associated adult assistant. The licensee was reminded that the assistant must be present at all times when there is more than 8 children in attendance. Whenever the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

The home is recommended for an increase of capacity. There are no deficiencies cited during today's inspection Please see attached Advisory Notes for additional information regarding technical violations issued today.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: GU, YUANYUAN	FACILITY NUMBER: 435700316
	VISIT DATE: 05/27/2022

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee 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 licensee 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 licensee 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.

Effective August 1, 2003 California Law requires Child Care 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 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Yuanyuan Gu.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

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