013422785-7-23-2024-52-CC-MPRE-D7FPXF-20240723114217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422785
Report Date: 07/23/2024
Date Signed: 07/23/2024 11:42:26 AM

Document Has Been Signed on 07/23/2024 11:42 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SONG, SHA		FACILITY NUMBER:	013422785
ADMINISTRATOR/ DIRECTOR:	SHA SONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 584-1955
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 14	DATE:	07/23/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Sha Song		TIME VISIT/ INSPECTION COMPLETED:	11:41 AM

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 7/23/2024 at 9:05am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Song Sha for an Unannounced Annual/Random Inspection. Present during the inspection was the Licensee, her adult helper, Licensee’s seventeen (17) year old daughter who was in a off limit area, two (2) school age children, three (3) infants and nine (9) preschool age children. Licensee's father was also present when LPA arrived, but left within minutes of LPAs arrival. Licensee stated he only maintains the garden in the mornings and does not help with the children. Licensee lives in the home with her husband and their three (3) minor children. Licensee’s home was toured for a health and safety inspection. The facility operates 8:00am – 6:00pm, Monday – Friday. ON LIMITS AREA: Living Room, Dining Area, Kitchen, Two (2) Bedrooms on the left side of the home (used as playrooms), Hallway Bathroom and Backyard OFF LIMITS AREA: Primary Bedroom with Bathroom and Garage ISOLATION AREA: Last Bedroom on the Left side of the Hallway The facility is a single-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children’s learning and play. All toxins, personal medication, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children which was observed to be properly maintained and stored. All food that may be brought from the children’s home will be properly labeled and stored. All off limit areas in the home are made inaccessible with gates, and locks. Licensee stated she does not transport children, there are no pets, and there are no firearms in the home. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SONG, SHA	FACILITY NUMBER: 013422785
	VISIT DATE: 07/23/2024

NARRATIVE

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There is one (1) 3A40BC fire extinguisher in the closet next to the kitchen island. There is a fire alarm, smoke detector, and carbon monoxide detector by the front door. There is a heater/air conditioner unit on the wall above the kitchen island for heat and proper ventilation. There are also plenty of windows in the home as well. Licensee uses mats and blankets for sleeping. There are two (2) play yards in the last bedroom on the left for infants sleeping. All napping equipment was observed to be clean and well maintained. Licensee uses child sized tables and chairs for activities and mealtimes and highchairs for infants. Licensee uses cubbies for the children in the entryway of the home for extra storage.

The backyard is fully fenced, clean, and well maintained with ample age-appropriate materials for the children. There is a wooden climbing structure that was observed to be sturdy and properly maintained. There are fruit trees around the yard and a garden that is fenced off on the right side. All plants outside were observed to be well maintained. LPA did not observe any bodies of water in or around the home that could be a potential danger to the children in care.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid is complete and expires 3/18/2025. Licensee’s Mandated Reporter training is complete and expires 12/26/2025. LPA obtained the fire/disaster drill log. Fire/disaster drills have been conducted and recorded within the last six (6) months with the last drill logged 2/1/2024. All required forms are posted and visible for public view by the front door of the home. LPA obtained a sample of the children’s files, the helpers file, and facility files. All files were complete.

No deficiencies were cited during LPAs inspection.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SONG, SHA	FACILITY NUMBER: 013422785
	VISIT DATE: 07/23/2024

NARRATIVE

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Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

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/.

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.

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

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SONG, SHA	FACILITY NUMBER: 013422785
	VISIT DATE: 07/23/2024

NARRATIVE

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

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

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.

Exit interview conducted and report was reviewed with the Licensee Sha Song.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC809 (FAS) - (06/04)

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