015700404-2-19-2025-52-CC-MPRE-DE2VTN-20250219154325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700404
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:43:36 PM

Document Has Been Signed on 02/19/2025 03:43 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/ DIRECTOR:	LIU, XIAOHUA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 703-1271
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94542
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 1	CENSUS: 1	DATE:	02/19/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Xiaohua Liu		TIME VISIT/ INSPECTION COMPLETED:	03:41 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 2/19/2025 at 2:00pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Xiaohua Liu for an unannounced annual/random inspection. Present during the inspection was the Licensee, her aunt, who serves as her helper, and one (1) preschool age child. Licensee’s parents, who were visiting, and her four (4) minor children (ages 15, 3 and two 5 month olds) were present in off-limit areas as well. Licensee lives in the home with her husband and five minor children, age 15, 10, 3 and two 5 month olds. 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, 2^nd 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 a two-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’s learning and play. Licensee provides all meals and snacks for the children and all food that is brought from the children’s home will be properly labeled and stored. Licensee uses high chairs and feeding chairs for meal times. All materials used for eating was observed to be well maintained, free from defect and in proper working order. Licensee provides sleeping mats and bedding for napping. All off-limit areas in the home are made inaccessible with locks and gates. Licensee stated she will transport children from Stonebrae Elementary School. Licensee has stated there are no firearms and there are no pets in the home. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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: 02/19/2025

NARRATIVE

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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. 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. LPA did not observe any harmful bodies of water in or around the home. There are no pools at the home.

The space used for children in the outside area is fully 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.

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 training is complete and expires 8/13/2025. Licensee’s Mandated Reporter training has expired. LPA informed Licensee that the training will need to be renewed by Monday, 2/24/2025. Licensee stated fire/disaster drills have been conducted and documented, log is complete with the last drill logged 12/30/2024. LPA verified all adults living and working in the home have obtained a criminal record clearance. All required forms are currently posted in the on-limit living room. LPA obtained the child’s files, and facility files. All files were complete.

No deficiencies were cited during LPAs inspection.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: 02/19/2025

NARRATIVE

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Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting 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.

During the exit interview, Licensee Xioahua Liu, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: 02/19/2025

NARRATIVE

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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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

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