<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700374
Report Date: 08/19/2022
Date Signed: 08/19/2022 01:31:19 PM

Document Has Been Signed on 08/19/2022 01:31 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
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: 6CENSUS: 6DATE:
08/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Ying-Li Mao; Hsin-Chia HsiehTIME COMPLETED:
01:40 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 August 19, 2022 at approximately 11:25am Licensing Program Analyst (LPA) Haderer arrived for an unannounced case management visit for a capacity change inspection. Present in the home today was licensees’ Ying-Li Mao and Hsin-Chia Hsieh and their 3 ½ year old daughter and 5 other children in care (1 four-year-old; 2 three-year-old; 2 two-year-old). Hours of operation remain the same at 8:30am to 5:00pm.

All requested documents were received for the increase of capacity application. The fire clearance for a capacity of 14 was received from the Fremont Fire Department on 08/11/2022. The Licensees’ were reminded to abide by the conditions of the fire clearance (day care not permitted in garage). Pull down alarm has been installed in the living room near the front door.



The Licensees’ were reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensees’ will comply with the capacity requirements for a small family child care home. A copy of the approved children ratios for large FCCH was printed and given to licensees’.

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.

Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensees’, the ISOLATION AREA will be in the on-limits bedroom near the daycare area away from the other children in care.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: 08/19/2022
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
26
27
28
29
30
31
32
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.

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.

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 licensees’, there are no firearms in the home.
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 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, one child's file was missing a signed LIC627 Consent for Medical Treatment and LIC700 ID form; one child's immunization records were missing see LIC809D for deficiencies. LIC9150 signed and dated (for small FCCH), reminded licensees' to get updated form for large FCCH. There are no infants in care at this time and therefore no infant safe sleep plans nor safe sleep logs required.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 08/19/2022
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
26
27
28
29
30
31
32
LPA discussed 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

There were 3 deficiencies issued today for records in children's files, see LIC809D

The home is recommended for increase of capacity to a Large Family Child Care home as of this day August 19, 2022. This report will remain on file for 3 years.

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

Exit interview conducted and report was reviewed with licensees’ Ying-Li Mao and Hsin-Chia Hsieh.

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

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/19/2022 01:31 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/19/2022 at 12:37 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: 08/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2022
Section Cited
CCR
102417(g)(7)

1
2
3
4
5
6
7
102417(g)(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician....
1
2
3
4
5
6
7
Licensee's will have parents complete the LIC700 form.
8
9
10
11
12
13
14

Based on record review the licensees' did have a completed LIC700 Emergency ID form (for 1 child) which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
Type B
08/26/2022
Section Cited
CCR104417(g)(7)

1
2
3
4
5
6
7
102417(g)(7) An emergency information card shall be maintained for each child.... and the parent's authorization for the licensee or registrant to consent to emergency medical care
1
2
3
4
5
6
7
Licensee's will have parents complete and sign the LIC627 form.
8
9
10
11
12
13
14

Based on record review the licensees' did not have a signed LIC627 Consent for Emergency Medical Treatment form (for 1 child) which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
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: 08/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/19/2022 01:31 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/19/2022 at 12:55 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: 08/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2022
Section Cited
CCR
102418(g)and(g)(1)

1
2
3
4
5
6
7
102418(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
(1) This requirement includes updating each child's PM 286 (6/95) immunizations when the
1
2
3
4
5
6
7
Licensee will obtain immunization records for this child and keep them in the child's file.
8
9
10
11
12
13
14
child is due to receive required immunizations after enrollment in the family day care home.

Based on record review the licensees' did have records of immunization (for 1 child) which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 08/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022


LIC809 (FAS) - (06/04)
Page: 5 of 5