015700404-3-5-2024-52-CC-MPRE-D33TNJ-20240305135248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700404
Report Date: 03/05/2024
Date Signed: 03/05/2024 01:52:53 PM

Document Has Been Signed on 03/05/2024 01:52 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, XIAOHUA		FACILITY NUMBER:	015700404
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	03/05/2024
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Xiaohua Liu		TIME COMPLETED:	01:51 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 3/5/2024 at 12:52pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Xiaohua Liu for an Unannounced Capacity Increase Inspection. Present during the inspection was the Licensee, her infant daughter, and two (2) preschool age children. Licensee’s home was toured for a health and safety inspection. 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 2^nd 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 This home was granted a fire clearance on 12/18/2023 from the Hayward Fire Department. The facility is two (2) story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children that is properly stored and maintained. All food that may be brought from the children’s home will be properly labeled and stored. Licensee stated there are no firearms and no pets in the home. Page 1 of 2

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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 2

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: 03/05/2024

NARRATIVE

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There is one (1) fully charged 2A10BC fire extinguisher in the downstairs closet. The fire alarm is placed on the wall in the living room. There is one (1) smoke detector in the on-limits living room and the playroom. 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 making the garage inaccessible to the children in care. All off limit areas have been made inaccessible with locks and gates. 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. LPA did not observe any harmful bodies of water in or around the home.

Licensee’s Health and Safety training with lead poisoning component is complete. Licensee’s Pediatric CPR and First Aid training is complete and expires 8/13/2025. Licensee’s Mandated Reporter training is complete and expires 10/2/2024. LPA obtained the fire/disaster drill log, log is complete with the last drill logged 10/22/2023. All adults living in the home have obtained a criminal record clearance. All required forms are posted and visible for public view in the on limits living room.

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.

A license for a large family childcare home has been granted today, 3/5/2024.

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

LPA used Focus Interpreting Cantonese interpreter #83995978 to review report with Licensee.

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

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC809 (FAS) - (06/04)

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