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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700121
Report Date: 04/04/2024
Date Signed: 04/04/2024 02:40:15 PM

Document Has Been Signed on 04/04/2024 02:40 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:HUANG, QINGFACILITY NUMBER:
015700121
ADMINISTRATOR/
DIRECTOR:
HUANG, QINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 876-7513
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/04/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee, Qing HuangTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Jyoti Saini and Randy Miranda met with licensee, Huang Qing for an announced case management visit. The Licensee lives in the house with her husband, mother, father and and three minor Children. This facility was on inactive status effective 07/2022 and would like to be placed back on active status. Per licensee, the operational hours will be Monday to Friday 8:30am- 5:30pm.
The house is two story; which consist of 4 bedrooms, 2.5 bathrooms, living room, dinning room, kitchen garage and backyard. As you enter, there is a gate at front with a courtyard leading to the front door.

On Limit Areas: Living room ( main day care) , dining room, half bathroom in the hallway and backyard.
Off Limit Areas: 1st floor kitchen area, entire upstairs level, and garage. The off-limit areas are made inaccessible by child safety gates, closed and/or locked doors and visual supervision.

LPAs and licensee inspected the facility for health and safety hazards. All hazardous materials have kept inaccessible to children in care. The fully fenced backyard area will be available for children in care. There are no pools, hot tubs or other accessible bodies of water. Licensee's CPR expired on 07/16/2024. Licensee’s Mandated Reporter Certificate is expired since 04/2022. The facility has a working carbon monoxide, smoke detector and charge 3A40BC fire extinguisher. Per licensee there are no guns or weapons in is barricaded to prevent the access. The Licensee has two small trampolines in the backyard. LPAs advised licensee that facility must comply with the manufacturer instructions listed on the trampoline, including supervision requirements, if any of the day care children are using it. During this visit the following items were addressed:

*Required forms for the facility and children's files.
*Required forms to be posted at the facility.
*Unusual Incident reporting requirements.

Infant safe sleep practices. A copy of the Child Care Providers Guide to Safe Sleep was provided.

This facility may not begin active status until the following is receive by the department.
-Mandated Reporter Training

An exit interview was conducted. A notice of Site Visit was issued and posted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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