013421208-1-11-2024-52-CC-AWRT-CZDVUT-20240111154516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421208
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:45:21 PM

Document Has Been Signed on 01/11/2024 03:45 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	LI, YUAN & CHAO, HSIN		FACILITY NUMBER:	013421208
ADMINISTRATOR:	CHAO, HSIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 713-8759
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	01/11/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Yuan Li and Hsin Chao		TIME COMPLETED:	03:50 PM

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	On January 11th, 2024 at approximately 2:10pm, Licensing Program Analyst (LPA) April Wright arrived for an Unannounced Required 3 Year Inspection and met with licensee Yuan Li. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during inspection were five (5) preschool age children and fingerprint cleared spouse Hsin Chao. LPA toured the facility to conduct a health and safety inspection. Hours of operation are 8:30am - 6:00pm Monday through Friday. The two story home consists of four bedrooms, two and one half bathrooms, kitchen, garage and backyard. The home was neat and orderly, with heating and ventilation for safety and comfort of children in care. There is a fireplace in the dining room area (day care room 2) that is blocked and inaccessible to children in care. The isolation area is the living room on couch which is a section away from other children in care. There are age appropriate toys that appear to be safe and in good condition. ON LIMITS Areas: Living room (daycare area #1), dining room (daycare area #2), hallway bathroom (right of daycare room #2), portion of backyard. OFF LIMITS Areas: Entire second floor which consist all four bedrooms, half bathroom and master bathroom, kitchen, garage, gated right side portion of the yard. The off limits areas will be made inaccessible by closed and/or locked doors and visual supervision. There is a child safety gate at the bottom of the stairs to prevent access to the upper level of the home. There are no pools, hot tubs or any other bodies of water present in the home. Per licensee there are no weapons or firearms in the home. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. The home has a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detector, fully stock First Aid Kit. and telephone. The licensee is in compliance with the immunization laws which pertains to all childcare providers. See LIC809 -C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, YUAN & CHAO, HSIN	FACILITY NUMBER: 013421208
	VISIT DATE: 01/11/2024

NARRATIVE

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LPA requested and reviewed the five (5) files of children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 1/8/2024. CPR/First aid certificate was completed and expires 2/19//2024 and Mandated Reporter training was completed on 4/24/2022. The licensee is in ratio today. All required forms are posted and visible for public review.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP . 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/resources/child-care-centers/

See LIC809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, YUAN & CHAO, HSIN	FACILITY NUMBER: 013421208
	VISIT DATE: 01/11/2024

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Li, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC809 (FAS) - (06/04)

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