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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700404
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:22:36 PM

Document Has Been Signed on 10/20/2023 02:22 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:LIU, XIAOHUAFACILITY NUMBER:
015700404
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Xiaohua LiuTIME COMPLETED:
02:19 PM
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On 10/20/2023 at 12:12pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Xiaohua (Eva) Liu for a Required – 1 Year Inspection. Present during the inspection was the Licensee and her one (1) year old daughter. There were no children present during the inspection. Licensee lives in the home with her husband, Canming Mai and their three (3) children, ages fourteen (14), eight (8) and one (1). The facility operates 8:00am – 5:00pm, Monday - Friday.

ON LIMITS AREA: Living Room, Playroom (next to living room), Downstairs Bathroom, Play Yard (Portion of outside yard connected to playroom) and upper portion of the brick paved driveway on left side of the home
OFF LIMITS AREA: Entire 2nd Floor, Dining Area, 2nd Living Room (next to Dining Area), Kitchen, Study (next to Kitchen), Balcony on the side of the Dining Area and Garage
ISOLATION AREA: Playroom

The facility is two story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee stated that she provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. Child sized tables are used for eating. All materials used for eating was observed to be clean and free from defects. All napping equipment was observed to be well maintained and free from defects. All off limit areas are made inaccessible with gates, locks, and closed doors. Licensee stated she does transport children from Stonebrae Elementary School. There are no pets and no firearms in the home.


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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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: LIU, XIAOHUA
FACILITY NUMBER: 015700404
VISIT DATE: 10/20/2023
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There is one (1) fully charged 2A10BC fire extinguisher in the downstairs closet. There is one (1) smoke detector in the on-limits living room that was observed to be beeping indicating the batteries needed to be changed. LPA informed Licensee that the batteries needed to be changed before children return to care. There is one (1) working smoke detector in the study as well. There is one (1) carbon monoxide detector in the hallway next to the playroom. The staircase leading to the second floor is gated and the stairs leading to the back of the home has an electronic security lock on the door. The fireplace in the living room that is on-limits is not in use and blocked making it inaccessible to the children in care. The home is equipped with central heat and air for proper ventilation.

The play yard portion of the outside area is fenced and has a gate that leads to the upper portion of the brick paved driveway on the left side of the home. There are ample age-appropriate materials for the children that are clean and free from defects. Licensee stated that she will only be using the driveway when there are one or two children present. LPA informed Licensee that full supervision will be required when using the driveway while the children are present. LPA did not observe any bodies of water in or around the home.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid has been complete and expires 8/13/2025. Licensee’s Mandated Reporter training is complete and expires 10/2/2024. Fire/disaster drills have not been conducted as Licensee has until 10/31/2023 to conduct the first drill. LPA instructed Licensee to submit a copy of the fire drill log to LPA Pringle once the drill is completed. All required forms are posted and visible for view in the on-limits living room. All adults living in the home have obtained a criminal record clearance. LPA obtained the children’s files, and facility files. All files were complete.

No deficiencies were cited during this inspection.






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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
Page: 3 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: LIU, XIAOHUA
FACILITY NUMBER: 015700404
VISIT DATE: 10/20/2023
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Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

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 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.

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


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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
Page: 4 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: LIU, XIAOHUA
FACILITY NUMBER: 015700404
VISIT DATE: 10/20/2023
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During the exit interview, Licensee Xiaohua Liu, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

LPA used Language Links Cantonese interpreter #12227 to review report with Licensee.

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

Exit interview conducted and report was reviewed with the Licensee Xiaohua Liu.




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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
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