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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700374
Report Date: 07/14/2022
Date Signed: 07/14/2022 10:08:38 AM

Document Has Been Signed on 07/14/2022 10:08 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:HSIEH, HSIN-CHIA & MAO, YING-LIFACILITY NUMBER:
015700374
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
07/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:04 AM
MET WITH:Ying-Li Mai and Hsin-Chia HsiehTIME COMPLETED:
10:15 AM
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On July 14, 2022 at approximately 8:00 Licensing Program Analyst (LPA) Russ Haderer met with licensees Ying-Li Mao and Hsin-Chia Hsieh for the purpose of conducting an announced pre-licensing / change of location inspection. The new CARE tool was used. Living in the home and present for the inspection were both licensees and their 3 ½ year-old daughter. The hours of operation will be Monday-Friday, 8:30am to 5:00pm.

The facility is a single-story home with 5 bedrooms and 2 ½ bathrooms; a living room (with a screened fireplace); kitchen; dining room; family room (day care area); attached 2-car garage; side and backyard area. There is a six-foot fence surrounding the perimeter of the backyard with a single swinging gate for access on the east side. There is an old non-functioning wall heater in the on-limits living room, a waiver will be issued to requires it will not to be in used during operation of the day care and remain cool to the touch.



Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in the on-limits bedroom near the daycare area away from the other children in care.

On-limit-areas include: Living room; family room (day care area); kitchen; dining room; bedroom on the left side of hall just off the family room; and ½ bathroom on the right side of the hall just outside of the family room; the side and backyard areas outside.

Off-limit-areas include: 3 Bedrooms down the hall on the right side of the living room; house bathroom and master bathroom and hallway leading to these bedrooms and bathrooms (there is a child gate to prevent access where the hallway meets the living room); bedroom / office on the right side of the hall just off the family room; the 2-car garage; and two small storage sheds on the west side of the backyard, All off limit areas are inaccessible by closed and/or locked doors and visual supervision.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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: HSIEH, HSIN-CHIA & MAO, YING-LI
FACILITY NUMBER: 015700374
VISIT DATE: 07/14/2022
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There are two new play structures in the back yard (a swing set and additional play structure with slides). The swing set will be off limits until it is properly secured to the ground. The other structure with the slides is approved and has a rubber mat for a soft landing at the bottom of the slide. There is a climbing monkey bars dome and a small playhouse that were observed to be safe and in good condition.

The home and the day care area and rooms are neat and clean, with heating and ventilation for safety and comfort and ample age appropriate toys. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

There is a fully charged 2A10BC fire extinguisher located in the kitchen. The facility has working (tested and functioning) combined smoke and carbon monoxide detector. Per licensee, there are no firearms in the home.
The licensees Pediatric CPR/First Aid certificates are current and expire on 9/19/2022. Mandated reporter training was completed on 11-7-2020. Preventative Health and safety has been completed, including the lead poisoning prevention training. LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.
The licensee rents the property and has childcare liability insurance with State National Insurance company, the policy expires in July 1, 2023.

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 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.

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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: HSIEH, HSIN-CHIA & MAO, YING-LI
FACILITY NUMBER: 015700374
VISIT DATE: 07/14/2022
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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

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.

The home is recommended for licensing as of this day July 14, 2022. This report will remain on file for 3 years.

A review of operating safely during the Covid-19 pandemic (RAST) was conducted.



Exit interview conducted and report was reviewed with the licensee Ying-Li Mao and Hsin-Chia Hsieh.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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