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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422565
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:52:09 PM

Document Has Been Signed on 10/20/2023 02:52 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:MA, YANXIAFACILITY NUMBER:
013422565
ADMINISTRATOR:MA, YANXIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 334-1337
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee, Ma YanxiaTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Ma Yanxia for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the helper. The Licensee arrived during the inspection since she was out to run some errands. Present during this inspection was Licensee and two helpers supervising one (1) infant and ten (10) preschoolers. This home is a single-story home consisting of three bedrooms, including the master bedroom, two bathrooms, dining room, kitchen, Garage, and backyard. The Licensee lives in the house with husband and three children. The hours of operation are 8:00 AM- 6:00 PM, Monday -Friday. The Licensee has Liability insurance through the Accord company.
ON-LIMIT AREAS are the living room (Main play area), kitchen, dining area, and hallway bathroom and backyard.
OFF-LIMIT AREAS are all three bedrooms, master bathroom, and Garage. All the off-limit areas are made inaccessible to children by locked doors, safety gates, and visual supervision.

LPA observed the following: The Daycare Area is clean, orderly, and equipped with age-appropriate toys and equipment for children, indoors and outdoors. The home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or fireplace in the Daycare area. There are child-size tables and chairs for snacks and activities. There are ample age-appropriate toys that appear safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. The napping room had cots in good condition, and each child had separate blankets. The blankets are washed weekly by the Parents. The outdoor play area is fenced and safe, with rubber mats for cushioning. The Licensee states there are no guns or weapons in the home. Licensee's CPR expires in 11/2023. The Licensee's helpers have active CPR on the file. Licensee and staff have completed mandated reporter training. The Licensee conducted the last emergency drill on 06/01/2023 and is properly logged. The Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children's files. All the files are complete and up to date. All required postings are properly posted. The Licensee documents 15 minutes sleep check.

see next page...
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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: MA, YANXIA
FACILITY NUMBER: 013422565
VISIT DATE: 10/20/2023
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During Inspection, 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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at 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/inspection-process.

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

There is no deficiency cited today.

Exit interview conducted and report was reviewed with the licensee, Yanxia Ma.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
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