015700117-3-9-2023-52-CC-AWRT-CPRRFE-20230309115901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700117
Report Date: 03/09/2023
Date Signed: 03/09/2023 11:59:07 AM

Document Has Been Signed on 03/09/2023 11:59 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	LEE, LINA		FACILITY NUMBER:	015700117
ADMINISTRATOR:	LEE, LINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 678-9284
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	03/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Lina Lee		TIME COMPLETED:	11:35 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 March 9th, 2023 @ 9:25AM, Licensing Program Analyst (LPA) April Wright arrived for an unannounced Annual/Random Inspection and met with Licensee Lina Lee. LPA disclosed the purpose of the inspection and was granted entry into the home by the licensee. Present for this inspection were nine (9) children and the licensee's fingerprint cleared assistant Sabina Alvarez Ruano. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 9:00am to 5:00pm. The two story home was clean and orderly, with heating and ventilation for safety and comfort of children in care. The isolation area is the living room which is a section away from other children in care. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There is a fully charged 2A10BC working carbon monoxide and smoke detectors, telephone, and first aid kit. There is a fireplace with a screen/glass doors and has a small bookcase for storage of children's toys placed in front. On limit areas include: Living/Dining/Family room (Day-care rooms), bathroom (near front door), and backyard. The outdoor play area is fenced and is free from defects and dangerous conditions Off-limits areas include: Entire second level of home, kitchen, and garage, The kitchen has a child safety gate and has child locks on cupboards. The off limits are and will be made inaccessible by closed and/or locked doors and visual supervision. There is a child safety gate at the bottom of the stairs to prevent access to the upper level of the home. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today’s inspection. There are age appropriate toys that appear to be safe and in good condition. Per licensee there are no firearms in the home. See LIC 809-C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LEE, LINA	FACILITY NUMBER: 015700117
	VISIT DATE: 03/09/2023

NARRATIVE

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Records Review: LPA Wright requested and reviewed the files of for nine (9) children in care. Children's files contained Immunization, Parent's Rights, and Medical Consent forms. The facility roster was reviewed, and copies were obtained. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 1/16/2023. CPR/First Aid certificate is current and expires 3/2024 and completed Mandated Reporter Training on 3/2/2022. The licensee is in ratio today and All required form are posted and visible for public review. Licensee does carry daycare insurance through Markel Insurance Company.

Incidental Medical Services (IMS) policy was discussed. No IMS services are being administered at this facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

LPA Wright discussed the Safe Sleep regulations with licensee and discussed Child Care Licensing Safe Sleep web page 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.

There are no deficiencies cited. A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was review with Licensee Lina Lee.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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