013421948-5-12-2022-52-CC-BPLY-CECTKY-20220512144842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421948
Report Date: 05/12/2022
Date Signed: 05/12/2022 02:48:51 PM

Document Has Been Signed on 05/12/2022 02:48 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:	MA, JING		FACILITY NUMBER:	013421948
ADMINISTRATOR:	MA, JING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 368-3911
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94546
CAPACITY:	14	CENSUS: 11	DATE:	05/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Jing Ma- Licensee		TIME COMPLETED:	03:00 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 05/12/22 at 1:45pm, Licensing Program Analysts Briana Plumboy and April Wright, met with licensee Jing Ma for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was 11 preschool age children, licensees fingerprint clear and associated husband Zhigang Jhang, and licensee's fingerprint clear and associated assistants Yanhong Li and Huan Xian Yang. The home was toured to conduct a Health and Safety Inspection. This facility currently operates Monday through Friday from 8:00am until 6:00pm. The home is a two story home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room which is converted into a classroom, kitchen, dining room, family room which has been converted into a playroom, the bathroom which is located 3 stairs down from the family room and has a barricade to prevent access to the stairs, and the deck in the yard. The OFF LIMIT AREAS are the entire second level of the home and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREAS are corners in the living room and family room. The stairs which lead to the second level of the home have a gate barricade located at the bottom, and there are barricades located throughout the on limit areas at the entrances and exits. The BACKYARD play area is fenced. The children only play on the deck in the yard and there is a gate on the stairs which lead to the entrance of the deck. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensees CPR and First Aid certificate is current and expires 05/01/23. The licensee Ms. Jing Ma and the assistants present today are in compliance with the provider immunization law. Licensee Jing Ma and her assistants currently have waivers for the mandated reporter training certificate until it is available in Mandarin. Licensee is aware once the mandated reporter training is available in See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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: MA, JING	FACILITY NUMBER: 013421948
	VISIT DATE: 05/12/2022

NARRATIVE

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Mandarin, herself and assistants must complete the training and receive certificates of completion. Per licensee, there is a firearm in the home but it is stored in an off limit area and the ammunition is stored separate. This facility has current Daycare insurance. The licensee conducts and documents fire/disaster drills with the last one conducted on 03/28/22. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

LPA discussed the safe sleep regulations with licensee Jing Ma 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 Jing Ma 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.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Jing Ma.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

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