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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700260
Report Date: 10/01/2021
Date Signed: 10/01/2021 09:48:39 AM

Document Has Been Signed on 10/01/2021 09:48 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WANG, DINGFACILITY NUMBER:
015700260
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:12 AM
MET WITH:Ding WangTIME COMPLETED:
09:45 AM
NARRATIVE
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On 10/1/2021 at 8:12am Licensing Program Analyst (LPA) Morgan Pringle met with applicant Ding (Kelly) Wang for an announced pre-licensing visit. Present during the inspection was the applicant Ding Wang, her fingerprint cleared husband, their 2 infant children and the applicant’s aunt. Licensee lives in the home with her husband, their 2 infant daughters and her aunt. The applicant’s home was then toured for a health and safety inspection. The facility plans to operate from 8:00am – 3:00pm Monday – Friday.

ON LIMITS AREA: Den, Living Room, Office/Bedroom, Backyard and Front Yard


OFF LIMITS AREA: Kitchen, Dining Room, Garage, Entire 1st floor and Entire 3rd Floor
ISOLATION AREA: Den

The facility is three story home owned by the applicant. The home consists of a Kitchen, Dining Room, Nook, Living Room, Den, Office/Bedroom, four (4) bedrooms, four (4) bathrooms, two (2) outside decks, Garage, Backyard, and Front Yard

The inside of the home and both outside areas are observed to be neat, clean with ample age appropriate materials for the children that are safe. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. The fireplace in the living room has been blocked and locked and the electric fireplace in the den is not used and made inaccessible to children. Applicant has stated that there are no firearms and one (1) dogs.


Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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: WANG, DING
FACILITY NUMBER: 015700260
VISIT DATE: 10/01/2021
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The home has one fully charged 3A40BC fire extinguisher in the nook. One working smoke detector is above the stairs that connect the second and third floors, in the master bedroom on the 3rd floor and the second-floor playroom. Licensee does not have a carbon monoxide detector. LPA has advised where to purchase one. Licensee will purchase a gate to place at the bottom of the stairs. The applicant’s Health and Safety training with the lead poisoning component has been completed and CPR and First Aid certificate is current and expires on 4/17/2023. Mandated Reporter training is complete and expires in 2023. The home is equipped with central heating and air for proper ventilation. Applicant provided proof of immunization for pertussis, measles, and the flu shot.

LPA discussed all records to be maintained, including children's files and required postings. COVID-19 postings were reviewed with applicant. LPA provided technical assistance regarding all COVID-19 policies and procedures.

Applicant was reminded that California Law requires 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 email. LPA informed the applicant that all forms can be downloaded at www.ccld.ca.gov. Applicant was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Applicant was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Applicant is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.



Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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: WANG, DING
FACILITY NUMBER: 015700260
VISIT DATE: 10/01/2021
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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-and-resources/safe-sleep as an additional resource. LPA also informed 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.
Applicant reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.This home has been recommended for a provisional license for a small family childcare home on 10/1/2021. Licensee will provide proof of gate at the bottom of the staircase as well as a carbon monoxide detector. LPA will then provide full license to Applicant. Exit interview conducted and report was reviewed with Ding Wang.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
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