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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700356
Report Date: 06/18/2024
Date Signed: 06/18/2024 11:47:38 AM

Document Has Been Signed on 06/18/2024 11:47 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WEN, QINFACILITY NUMBER:
015700356
ADMINISTRATOR/
DIRECTOR:		WEN, QINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 996-8650
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Qin WenTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 6/18/2024 at 9:50AM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Qin Wen for an Annual/Random visit. Present during the inspection was the Licensee, fingerprint cleared owner of the home, 2 preschool aged children, and 2 infants. Licensee’s home was toured for a health and safety inspection. The facility operates from 8:30AM – 6:00PM, Monday - Friday.

ON LIMITS AREA: Living Room, Hallway Bathroom and Front Portion of the Backyard (separated with safety gates)
OFF LIMITS AREA: All 3 Bedrooms, Kitchen, Master bathroom, outside of the fenced off portion of the backyard and Garage
ISOLATION AREA: Living Room

The facility is a single-story home rented by the Licensee. The inside of the home was observed to have age-appropriate materials for the children. During today's inspection all toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. All off-limit areas are made inaccessible with gates and locks. Currently some children bring their food from home, and licensee provides food as well. Licensee stated that they do not transport children. There are no pets and no firearms in the home.

The home has a fully charged 2A10BC fire extinguisher in the home. There is a working combination smoke/carbon monoxide detector in the home. The home is equipped with central heat and window air conditioning units for proper ventilation. LPA observed all bedding is clean and in good condition. The fireplace in the living room is gated and blocked making it inaccessible to the children in care. The backyard is fully fenced and well maintained with age-appropriate materials for the children. The area used for childcare is fenced as well making the off-limit area of the backyard inaccessible. LPA did not observe any bodies of water in or around the home.
Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WEN, QIN
FACILITY NUMBER: 015700356
VISIT DATE: 06/18/2024
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LPA review 4 children's files and found them to be complete. Licensee’s Health and Safety training with lead poisoning component has been completed. Licensee’s Pediatric CPR and First Aid training's are complete and expires 4/15/2025. Licensee’s Mandated Reporter training certificate is complete and expires 6/1/2026. Fire/disaster drills have been conducted with the last drill logged 3/13/2024. All adults living and working in the home have obtained a criminal record clearance. All required forms are posted and visible for public view in the entry way of the home.

There were no deficiencies cited on today's visit.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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 at https://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.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WEN, QIN
FACILITY NUMBER: 015700356
VISIT DATE: 06/18/2024
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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/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Qin Wen, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



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

A notice of site visit was given to licensee Qin Wen and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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