013423935-3-8-2024-02-CC-BCRS-D3739D-20240308170258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423935
Report Date: 03/08/2024
Date Signed: 03/08/2024 05:03:14 PM

Document Has Been Signed on 03/08/2024 05:03 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:	CHEN, DONGYAN		FACILITY NUMBER:	013423935
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/08/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Dongyan Chen		TIME COMPLETED:	05:15 PM

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On 3/8/2024 at 2PM, Licensing Program Analyst (LPA) Brittany Crass, conducted an announced pre-licensing inspection and met with applicant Dongyan Chen. LPA disclosed the purpose of the inspection and was granted entry into the facility by the applicant. Entrance Checklist was provided. Residing in the home are the applicant, applicants husband, and applicants two school aged children. Present during todays’ inspection was the applicant, her husband, and her two children which arrived later on in the inspection. There are currently no pets. The facility was toured to conduct a health and safety inspection. The applicant plans to operate Monday through Friday from 7:30am-6pm.

This home is a two story house consisting of 3 bedrooms, 2 bathrooms, a living room, dining room, kitchen, laundry room, and garage. There is also a fully fenced in backyard. The home was observed to be neat and clean with heating and ventilation for safety and comfort of the children.

On-limit-areas are: the living room, dining room, downstairs bathroom, and fenced in play area section of the backyard.

Off-limit-areas are: the kitchen, downstairs bedroom, and the entire upstairs, which are made inaccessible by closed and/or locked doors, gates, and visual supervision.

Outdoor play area: includes a fenced off section of the backyard.

Isolation area: the couch in the living room.

There are no bodies of water or pools accessible to children in care during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There's a fireplace in the living room and an open-faced heater in the dining room, both are blocked to prevent children access. Per applicant there are no firearms in the home. The applicant will not be providing Overnight Care, or transporting children.

(Report continues, see 809-C)

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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: CHEN, DONGYAN	FACILITY NUMBER: 013423935
	VISIT DATE: 03/08/2024

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The home has a fully charged 2A10BC fire extinguisher in the closet by the front door, a working combination smoke/carbon monoxide detector outside of the bathroom, and a working telephone. The applicant’s CPR certificate expires on 8/10/2025 and the Mandated Reporter Certificate expires on 6/12/2025.

Applicant 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, 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.

Applicant owns the home and provided proof of control of property.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed the applicant 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.

(see 809-C)

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHEN, DONGYAN	FACILITY NUMBER: 013423935
	VISIT DATE: 03/08/2024

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On, 2/2/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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

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-carelicensing/subscribe and select the Child Care option to receive email communication.

Appeal rights were provided and discussed, and report was reviewed with applicant Dongyan Chen.

Corrections to be made: Applicant will submit LPA a photo showing a gate was placed at the bottom of the stairs in order to be licensed.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

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