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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700356
Report Date: 01/30/2023
Date Signed: 01/30/2023 10:55:14 AM

Document Has Been Signed on 01/30/2023 10:55 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:WEN, QINFACILITY NUMBER:
015700356
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
01/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Qin WenTIME COMPLETED:
11:05 AM
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On January 30, 2023 at 9:15am Licensing Program Analyst (LPA) Julia Placencia arrived to the facility unannounced for a case management inspection to determine if the facility is ready for an INCREASE IN CAPACITY. LPA met with Licensee Qin Wen. Also residing in the home is Hua Yang. There was one infant and one preschool age child present during today's inspection. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for child care are Monday through Friday, 8:30am to 6:00pm.

The home is a single story house which consists of a kitchen, living room, three bedrooms, two bathrooms, garage and a backyard. The home is neat and clean, with heating and ventilation for safety and comfort.

ON LIMITS: Kitchen, living room (day care room), hall bathroom and backyard play area. The isolation area will be in the day care room on the sofa away from the other children.

OFF LIMITS: Kitchen, all three bedrooms, rear and both side yards beyond the gated children's play area, garage. All OFF LIMITS areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an OFF LIMITS area to ON LIMITS. Per the fire clearance, day care activities are not permitted in garage.

The outdoor play area is the gated play area. There is a fence surrounding the perimeter of the backyard. There are ample age appropriate toys that appear to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible. The home has a fully charged 2A10BC fire extinguisher, working carbon monoxide and smoke detectors and telephone. The fireplace is barricaded with a child proof gate. Per licensee, there are no firearms in the home, nor are there any pets. The licensee conducts and documents fire/disaster drills at least every six months, and the last drill was conducted on 9/1/22.
***Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WEN, QIN
FACILITY NUMBER: 015700356
VISIT DATE: 01/30/2023
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All required licensing forms are posted and visible for public review. Children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensees' Pediatric CPR/First Aid certificate expires 3/2023, and mandated reporter training expires 10/16/24. The licensee is in compliance with immunization law.

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.

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.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.



LPA discussed the safe sleep regulations with licensee 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 licensee 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.

***Continued on LIC 809C...

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: WEN, QIN
FACILITY NUMBER: 015700356
VISIT DATE: 01/30/2023
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On 1/25/23, a fire clearance was granted to this facility by the Fremont Fire Department. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

As of today's date, January 30, 2023, this home is recommended for an increase of capacity. There are no deficiencies cited today.



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

Exit interview conducted and report was reviewed with the licensee Qin Wen.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023
LIC809 (FAS) - (06/04)
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