013423325-9-10-2024-52-CC-MPRE-D8YQXY-20240910123418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423325
Report Date: 09/10/2024
Date Signed: 09/10/2024 12:34:30 PM

Document Has Been Signed on 09/10/2024 12:34 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:	LI, QING YUN		FACILITY NUMBER:	013423325
ADMINISTRATOR/ DIRECTOR:	LI, QING YUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 816-9681
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 12	DATE:	09/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:22 AM
MET WITH:	Qing Yun Li		TIME VISIT/ INSPECTION COMPLETED:	12:33 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 9/10/2024 at 10:22am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Qing Yun Li for an unannounced annual/random inspection. Present during the inspection was the Licensee, her adult helper, three (3) infants, and nine (9) preschoolers, and one (1) school age child. Licensee lives in the home with her husband, and their minor son. Licensee’s home was toured for a health and safety inspection. The facility operates from 8:00am – 6:00pm, Monday – Friday. ON LIMITS AREA: Living Room, Hallway Bathroom, 1^st Bedroom on the Right side of the Hallway (used for infant napping), Kitchen, Dining Room and Backyard OFF LIMITS AREA: Primary Bedroom and attached Bathroom, 2^nd Bedroom and Garage ISOLATION AREA: On-Limit Bedroom 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. During the inspection LPA observed adult medication on a table in the on limit bedroom used for napping and adult vitamins on the ledge of the kitchen counter that was accessible to the children. Licensee immediately removed all of the exposed medication and vitamins and placed them in inaccessible off limit areas (see LIC809D). 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 locks, gates, and closed doors. Licensee stated she does not transport children, there are no firearms and there are two (2) small dogs in the backyard that do not come into the home. License stated the dogs will be in the garage on rainy days as well. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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: LI, QING YUN	FACILITY NUMBER: 013423325
	VISIT DATE: 09/10/2024

NARRATIVE

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There is one (1) fully charged 2A10BC fire extinguisher in the garage. There is one (1) working smoke detector in the kitchen, dining area and hallway and one (1) carbon monoxide detector in the hallway. The home is equipped with central heat and plenty of windows and fans for proper ventilation. The fireplace in the dining area is blocked by furniture making it inaccessible to the children in care. Licensee uses a child sized table and chairs for mealtimes along with highchairs. LPA observed play yards, cribs, and child sized mats used for napping. All children’s napping materials were observed to be properly maintained and stored. The backyard is fully fenced with ample age-appropriate materials for the children in care. LPA did not observe any harmful bodies of water in or around the home.

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 training is complete and expires 1/15/2025. Licensee’s Mandated Reporter training is complete and expires 5/1/2025. 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 4/19/2024. All adults living, working, and volunteering in the home have obtained a criminal record clearance. All required forms are posted on the wall by the front door. LPA obtained a sample of the children’s files, and facility files. All files were complete.

Deficiencies cited during LPA’s inspection
· Medications and vitamins left in accessible areas

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.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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: LI, QING YUN	FACILITY NUMBER: 013423325
	VISIT DATE: 09/10/2024

NARRATIVE

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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.

During the exit interview, Licensee Qing Yun Li, 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.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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: LI, QING YUN	FACILITY NUMBER: 013423325
	VISIT DATE: 09/10/2024

NARRATIVE

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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 Qing Yun Li.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/10/2024 12:34 PM - It Cannot Be Edited

Created By: Morgan Pringle On 09/10/2024 at 11:58 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, QING YUN	FACILITY NUMBER: 013423325
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed a basket of perscription medicines on a bedside table in the on-limit bedroom and liquid and pill form vitamins on the edge of the kitchen counter that was accessible to the children in care. Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/10/2024
	Plan of Correction
1 2 3 4	Licensee immediatly removed all of the items and placed them in off-limit inaccessible areas of the home. Licensee will ensure to keep all hazaderous materials in inaccessible areas moving forward.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Jason Jang

LICENSING EVALUATOR NAME:

Morgan Pringle

LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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