015700374-5-31-2023-52-CC-RHAR-CSCTHB-20230531144427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700374
Report Date: 05/31/2023
Date Signed: 05/31/2023 02:44:39 PM

Document Has Been Signed on 05/31/2023 02:44 PM - 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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HSIEH, HSIN-CHIA & MAO, YING-LI		FACILITY NUMBER:	015700374
ADMINISTRATOR:	MAO, YING LI & HSIEH, HSIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 905-9682
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 10	DATE:	05/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Ying-Li Mao and Hsin-Chia Hsieh		TIME COMPLETED:	02:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 31, 2023 at approximately 11:45am Licensing Program Analyst (LPA) Haderer arrived for an unannounced annual inspection. Present in the home today was licensees’ Ying-Li Mao and Hsin-Chia Hsieh, their 4 ½ year old daughter and 9 other children in care (3 four years old; 3 three years old; 4 four years old). Hours of operation remain the same at 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 with a waiver requiring it not to be in used during operation of the day care and remain cool to the touch. Per the licensees’, 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 right 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 left 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: 05/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSIEH, HSIN-CHIA & MAO, YING-LI	FACILITY NUMBER: 015700374
	VISIT DATE: 05/31/2023

NARRATIVE

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There are play structures in the back yard: a swing set; additional play structure with slides; and climbing monkey bars dome and a small playhouse. The swing set is attached firmly to the ground, all items 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, however, the child-proof locks in the kitchen draw with knives has worn out. The child-proof lock on door for the kitchen sink is failing and needs to be replaced – see LIC809D for deficiency.

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. The last fire drill was completed on August 10, 2022, more than 6 months ago – see LIC809D for deficiency. Per licensees’, there are no firearms in the home.

Licensees’ Pediatric CPR/First Aid certificates are current and expire on 9/03/2024. Mandated Reporter certificate has expired for both licensees, expired on November 7, 2022 – see Technical Violation. Preventative Health and safety have been completed, including the lead poisoning prevention training. LPA reminded the licensees’ 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.

Licensees’ rent the property and has childcare liability insurance with State National Insurance company, the policy expires in July 1, 2023.

Children’s files were reviewed, a copy of the roster was taken by the LPA for the office file. Three children’s files had immunization records but the PM286 Blue immunization card was not updated – see Technical Violation. All other files were complete and in good order. There are no infants in care at this time and therefore no infant safe sleep plans nor safe sleep logs are required.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSIEH, HSIN-CHIA & MAO, YING-LI	FACILITY NUMBER: 015700374
	VISIT DATE: 05/31/2023

NARRATIVE

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Although licensees do not have infants in care at this time, LPA reviewed the safe sleep regulations with licensees’ 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 licensees’ 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.

Licensees’ were 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.

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSIEH, HSIN-CHIA & MAO, YING-LI	FACILITY NUMBER: 015700374
	VISIT DATE: 05/31/2023

NARRATIVE

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The following two deficiencies was observed during today's inspection:

- Disaster drills are required every six months the most recent drill was completed in August, 9 months ago

- Child-proof latches in the kitchen have worn out and/or are not functioning properly ensuring inaccessibility

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

**Please see LIC 9102 for Advisory Notes.

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

Exit interview conducted and report was reviewed with licensee Ying-Li Mao.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/31/2023 02:44 PM - It Cannot Be Edited

Created By: Russell Haderer On 05/31/2023 at 01:48 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSIEH, HSIN-CHIA & MAO, YING-LI	FACILITY NUMBER: 015700374
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that child-proof latches have worn out and/or are not functioning properly which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/05/2023
	Plan of Correction
1 2 3 4	Licensees to purchase new latches and install them on the doors under the kitchen sink and drawer next to the stove (or move knives to an upper cabinet).

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that last disaster drill was done on August 10, 2022, 9 months ago which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2023
	Plan of Correction
1 2 3 4	Licensees to conduct a disaster drill (fire or earthquake) and going forward complete a drill at least once every six months.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Chandra Charles

LICENSING EVALUATOR NAME:

Russell Haderer

LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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