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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700117
Report Date: 07/26/2024
Date Signed: 07/26/2024 12:17:53 PM

Document Has Been Signed on 07/26/2024 12:17 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LEE, LINAFACILITY NUMBER:
015700117
ADMINISTRATOR/
DIRECTOR:		LEE, LINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 678-9284
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Lina LeeTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On July 26th, 2024, approximately 9:50am, 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 twelve (12) children (2 infants, 9 preschool,1 TK) and the licensee's 2 fingerprint cleared assistants. 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.

On limit areas include: Living/Dining rooms (Day-care room 1 and 2), downstairs bathroom (near front door upon entry to home), and backyard.
Off-limits areas include: Entire second level of the home which includes all bedrooms, master and remaining bathroom, kitchen, and garage. The off limits area are and will be made inaccessible by closed and/or locked doors and visual supervision.

The two story home consists three bedrooms, two and one half bathrooms that include master bathroom, Living room, Kitchen, Dining area, backyard and garage. The home neat and orderly with heating and ventilation for safety and comfort of children in care. LPA observed that the outdoor play area is fenced, free of defects and damage. There are age appropriate toys and furniture that LPA observed to be in safe and good condition, free of visible damage or hazards. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible during today's inspection and were made inaccessible to children in care.
There is a fully charged 2A10BC fire extinguisher located in the kitchen mounted on the wall. Licensee has working carbon monoxide/smoke detectors and a stocked first aid kit. LPA observed and Licensee confirmed that there are no pools, hot tubs or any bodies of water present in the home. The fireplace has a glass gate which is locked a gate and blocked by toy shelf making it inaccessible to children in care. Licensee confirmed that there are no pets, firearms or weapons in the home. See LIC809 -C for continuance
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE, LINA
FACILITY NUMBER: 015700117
VISIT DATE: 07/26/2024
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All individuals subject to criminal record review have a clearance or exemption and have been associated to this FCCH. LPA requested and reviewed the files of six (6) children in care. The children's files contained, Parents rights, medical consent forms, identification and emergency contacts. The children's roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 6/3/2024. The licensee has current Mandated reporter training which was completed on 6/15/2024 and CPR/First aid certificate is current and expires 6/2025. Licensee is in ratio today. All required forms are posted and visible for public viewing. Licensee carries daycare insurance and LPA reviewed and verified the policy.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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/.

See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE, LINA
FACILITY NUMBER: 015700117
VISIT DATE: 07/26/2024
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During the exit interview, the Licensee Lee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Lina Lee.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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