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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422565
Report Date: 10/23/2024
Date Signed: 10/23/2024 11:29:32 AM

Document Has Been Signed on 10/23/2024 11:29 AM - 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/
DIRECTOR:		MA, YANXIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 334-1337
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Licensee, Yanxia MaTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Yanxia Ma for an unannounced annual random inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by a helper. Present during this inspection were the licensee and two helpers supervising 11 preschoolers. This is a single-story home consisting of three bedrooms (including the master bedroom), two bathrooms, a dining room, a kitchen, a garage, and a backyard. The hours of operation are 8:00 AM to 6:00 PM, Monday through Friday. The licensee has liability insurance through Acord Insurance.

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, and Garage. All the off-limit areas are made inaccessible to children by locked doors, safety gates, and visual supervision.

The facility uses the living room as the main day-care area. The living room is equipped with age-appropriate toys and activities. A carpet is placed in the middle for circle time, and there are child sized tables and chairs in the dining area that the kids use for daily activities and snacks. The home has a working telephone, a functioning smoke and carbon monoxide detector, and a fire extinguisher that meets minimum requirements. During today’s inspection, the LPA did not observe any bodies of water or a fireplace. The licensee confirmed that there are no firearms stored in the house. Each child has a separate cot and bedding. Per licensee, the bedding is washed weekly by the parents. LPA observed that each child has their own water bottle, which is labeled with their names. The outdoor play area is fenced and safe, with rubber mats for cushioning. The backyard features a play structure, four spring riders, and three plastic picnic tables. The licensee and helpers hold current CPR and first aid certifications, which expire in November 2025. The licensee and staff have also completed mandated reporter training. The licensee conducted the last emergency drill on October 21, 2024, and it is properly logged. The licensee provides daily snacks and meals. The LPA reviewed the children's and staff files, which are complete and up to date. All required postings are posted. Although the licensee does not have infants enrolled, licensee acknowledged her understanding of safe sleep guidelines. The facility roster was reviewed, and a copy was obtained.

see next page..

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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: MA, YANXIA
FACILITY NUMBER: 013422565
VISIT DATE: 10/23/2024
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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: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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