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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700260
Report Date: 12/15/2022
Date Signed: 12/15/2022 10:05:25 AM

Document Has Been Signed on 12/15/2022 10:05 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: 4CENSUS: 0DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Ding WangTIME COMPLETED:
10:01 AM
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On 12/15/2022 at 9:05am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Ding (Kelly) Wang for an Announced Capacity Increase Inspection. Present during the inspection was the Licensee, her mother and father, her two (2) three (3) year old daughters and four (4) month old son. Licensee lives in the home with her fingerprint cleared husband Y. Feng, their three (3) children and Licensee's mother, J. Zhang, and father, H. Wong. The Licensee’s home was then toured for a health and safety inspection. The facility operates from 8:30am – 5:30pm Monday – Friday.

ON LIMITS AREA: Kitchen, Dining Area, Den, Living Room, Office/Bedroom, 1st Floor Living Room and Attached Balcony, Backyard and Front Yard
OFF LIMITS AREA: Dining Room, 1st Floor Bedroom and Storage Area, Entire 3rd Floor and Garage
ISOLATION AREA: Den

During LPA's inspection a request was made to make the kitchen, dining area, 1st floor living room and attached balcony on-limits. LPA inspected the areas and approved the modifications. Licensee will send LPA new facility sketch of the home notating the changes.

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

Licensee was granted a fire clearance on 12/12/2022 from the Hayward Fire Department.

Continued on LIC809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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: 12/15/2022
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The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. 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. The stairs leading to the third floor is gated and the stairs leading to the first floor has a door that is closed off to the children in care. There is also a gate at the bottom of the stairs. LPA did not observe any harmful bodies or water in or around the home. The front yard, backyard and balcony are fully fenced with locking gates. There are swings and a play structure in the back yard of the facility. All structures are secured into the ground and made safe for children in care.

The home has one fully charged 3A40BC fire extinguisher in the laundry room. One working smoke detector is above the staircase that connects the second and third floors, in the office/bedroom and in the 1st floor living room. There was a pull down alarm installed by the front door and exit signs are posted throughout the home. The carbon monoxide detector is located in the kitchen. The home is equipped with heat and air for proper ventilation. Licensee has stated that there are no firearms and one (1) dog in the home.

The Licensee Health and Safety training has been completed. Licensee Pediatric CPR and First Aid training is complete and expires 4/17/2023. Licensee’s Mandated Reporter training is complete and expires 6/10/2023. Fire/disaster drill log is complete with the last drill dated 8/10/2022.

Licensee was 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.



Capacity increase has been granted as or 12/15/2022.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Ding "Kelly" Wang.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC809 (FAS) - (06/04)
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