015700089-5-13-2021-52-CC-JWIN-C2YQN7-20210513121840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700089
Report Date: 05/13/2021
Date Signed: 05/13/2021 12:18:54 PM

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:	LIN, JOANNA		FACILITY NUMBER:	015700089
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	05/13/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Joanna Lin		TIME COMPLETED:	12:15 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 05/13/2021 at approximately 10:15am, Licensing Program Analyst (LPA) Jabari Wilson conducted an announced Case Management Inspection with Licensee Joanna Lin. Present for the inspection was the Licensee's husband, Jason Lin, and 4 infants in care, including Licensee's 8-month-old son. The home was toured with the Licensee to conduct a health and safety inspection. Licensee states the hours of operation for daycare will be Monday through Friday 8:00AM - 5:30PM. This is a one story home which consists of three bedrooms, two bathrooms, a living room which has been converted into a playroom, a family room, a kitchen and dining area, a laundry room, a garage, and a large backyard that is completely fenced. The lower kitchen cabinets are inaccessible via child safety locks. The First Aid kit is readily available in a reachable compartment situated within the living room/daycare. Storage units/closets within the hallway do not contain hazardous materials to children, nor does the on-limit bedroom. There are child safety doorknobs on all off-limit bedroom doors to prevent access to children. The ISOLATION ROOM will be the on-limits bedroom adjacent to the children's bathroom located in the hallway. The Off-limit areas will be inaccessible by child safety gates, child safety doorknobs, closed and/or locked doors, and visual supervision. ON LIMITS: The living room/daycare, the bedroom located on the left-hand side of the hallway, and the bathroom directly across from the on-limits bedroom. OFF LIMITS: The kitchen and dining area, the bathroom located near the kitchen and dining area, the laundry room, the furthermost bedrooms down the hallway towards the garage, the garage, and the backyard. SEE 809-C FOR CONTINUANCE

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Jabari Wilson	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

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: LIN, JOANNA	FACILITY NUMBER: 015700089
	VISIT DATE: 05/13/2021

NARRATIVE

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There is a fully charged 3-A:40-B:C fire extinguisher, a working dual carbon monoxide/smoke detector, and a pull down fire alarm which meet State Fire Marshall standards during today's inspection.

Per the Licensee, there are no firearms in the home. A copy of the Property Tax Statement was reviewed and shows control of property by Jason and Joanna Lin. There are no pets in the home. All required licensing documents are posted and visible for public review. The Licensee's Pediatric CPR/First Aid certificate is current and expires 02/27/2023. Licensee's mandated reporter training was completed on 04/11/2021. Licensee is in compliance with the immunization laws.

LPA reminded the Licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports. The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

On 05/11/2021, a fire clearance was granted to facility #015700089 by Alameda County Fire Department. All documents have been received 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.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

As of 05/13/2021, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the Licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Wilson. The Licensee is aware the signature on this report confirm receipt of these documents. LPA asked the Licensee if she had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the Licensee. An exit interview was conducted, and appeal rights provided.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Jabari Wilson	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC809 (FAS) - (06/04)

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