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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418831
Report Date: 07/20/2022
Date Signed: 07/20/2022 01:59:50 PM

Document Has Been Signed on 07/20/2022 01:59 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:CHOU, LEI LUCYFACILITY NUMBER:
013418831
ADMINISTRATOR:CHOU, LEI LUCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 818-0982
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Lei Lucy ChouTIME COMPLETED:
02:10 PM
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On 07/20/2022 approximately at 11:45AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Lei Lucy Chou. Present for this inspection was the licensee, licensee's fingerprinted and associated husband/helper, along with 6 preschool aged children. Licensee's adult children does not reside at the facility. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am to 6:30pm.

ON LIMITS: bathroom #1 and living room
OFF LIMITS: Entire second floor which includes a bedroom and a bathroom #2, and kitchen. Off limit areas are inaccessible by closed and/or locked doors, gate for the staircase, and visual supervision.

The home is apartment complex, which is neat and clean, with heating and ventilation for safety and comfort. A child safety gate is being used at the stairway as the Licensee is using a gate to keep children in the living room area. At 12:00PM, LPA observed there were ample age appropriate toys that were observed to be safe and in good condition. LPA reminded licensee to not have any objects such as blankets or toys inside the play pen; licensee understood and states that the play pen is only being used for playing and not sleeping as children are sleeping on mats. At 12:15PM, LPA also observed two bottles of bleach in the bathroom floor that the licensee immediately store it in an inaccessible area. Technical Violation was cited. In the kitchen area, LPA reminded licensee to have child locks on the drawers to prevent children from accessing potential hazardous items as one of the cabinets were not locked properly. Licensee understood. There were a fully charged 2A10BC fire extinguisher, working carbon monoxide, smoke detectors, and telephone. The home has central heating system. Per licensee, there are no firearms or pets or any bodies of water in the home. The licensee conducts and documents fire drill log indicates a drill was conducted 04/01/22. All required licensing documents are posted and visible for public review.

SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: CHOU, LEI LUCY
FACILITY NUMBER: 013418831
VISIT DATE: 07/20/2022
NARRATIVE
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At 12:50pm, 6 children's files were reviewed and found that LIC 613A (Children Personal Rights form) is missing from all children files. LPA advised licensee to have forms signed by children parents. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Per licensee, she does not have her immunization records as she sent it with her renewal paperwork for her CPR and First Aid; licensee states she would send LPA a copy once it is returned to her. The licensee have required mandated reporter training that is completed as of 07/06/2022. Both licensee and her husband/helper has CPR and First Aid training valid until 09/01/2022. Per licensee, she has registered for a renewal class with her church but has not received additional information about it yet; she explains she would update LPA once she gets a new card along with if she wants to continue to operate her day care in her new location.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Lei Lucy Chou

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.

SEE LIC 809 C


SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
Page: 4 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: CHOU, LEI LUCY
FACILITY NUMBER: 013418831
VISIT DATE: 07/20/2022
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Incidental Medical Services (IMS) policy was discussed. This facility does not provides IMS to children in care at this time. 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.”

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.


Licensee was reminded that California Law requires licensed Child Care Centers 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 by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.


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.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
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