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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423866
Report Date: 09/24/2024
Date Signed: 09/24/2024 04:07:30 PM

Document Has Been Signed on 09/24/2024 04:07 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HAO, JIAFACILITY NUMBER:
013423866
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/24/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Jia HaoTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 9/24/2024 at 3:30 PM Licensing Program Analyst (LPA) Janai McClain met with Licensee Jia Hao for an Unannounced Capacity Increase Inspection. Present during the inspection were one fingerprint cleared assistant, two infants, and three preschool age children in care. The Licensee’s home was toured for a health and safety inspection. The facility operates Monday-Friday 8:30 AM-5:00 PM.

LPA toured the home with the applicant to conduct a health and safety inspection. LPA observed that it is neat and clean with heating and ventilation for the safety and comfort of children. The home consists of a living room, kitchen, bedroom, two bathrooms, and family room/child care room.

On Limit Areas - entire home

Isolation Area - living room

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, bodies of water, hazardous items or poisons accessible to children during the inspection today.

This home was granted a fire clearance on 7/18/24 from the Oakland Fire Department.

*******************************Report Continues on LIC 809-C*******************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HAO, JIA
FACILITY NUMBER: 013423866
VISIT DATE: 09/24/2024
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The applicant stated there are no firearms in the home. The home is equipped with a fully charged 3A40BC fire extinguisher, a working combination smoke and carbon monoxide detector, and a telephone. There is a pull down fire alarm near the front door. Licensees CPR and first aid certificate expires 3/2026. Applicant has completed the Mandated Reporter training on 2/16/2023.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.


All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.



As of 9/24/24 the home has been approved to operate as a large family day care license.

Exit interview conducted and report was reviewed with the Licensee Jia Hao.

Appeal Rights provided.

Notice of Site Visit must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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