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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700453
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:43:30 PM

Document Has Been Signed on 04/20/2023 02:43 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WU, GUIZHENFACILITY NUMBER:
015700453
ADMINISTRATOR:GUIZHEN WUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 876-7513
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Guizhen WuTIME COMPLETED:
03:20 PM
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On April 20, 2023 at approximately 01:15pm Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an announced Pre-licensing Inspection at Guizhen Wu home and met with applicant Guizhen Wu and daughter Michelle Huang (translation proposes/does not live in the home) who has applied for a Large Family Child Care Home with a capacity of 14 children. The home was toured to conduct a Health and Safety Inspection. The Child Care home plans to operate Monday - Friday 08:30AM - 5:30 PM. Living in the home is applicant Guizhen Wu and fingerprint cleared husband, Liping Lu.

This is a two story town home with 3 bedrooms and 2.5 bathrooms, living room, dining-room, kitchen and garage. The home appears to be neat and clean with heating and ventilation for safety.

ON LIMIT AREAS: Living Room, dining-room, half bathroom first floor, and Bedroom on the main level. Isolation Area: Bedroom away from the children in care, until parents pick up.

OFF-LIMIT AREAS: Entire 2nd level consisting of master bedroom and bathroom, 1 bedroom, bathroom and two car garage. The rear side yard is completely off limits, during today's inspection the hot tub did not have the proper latch to lock according to licensing regulations. Application was informed that when she has removed or added the proper lock the LPA will return to inspect. These areas will be off-limits by safety gates, closed locked doors and visual supervision.

OUTDOOR SPACE: LPA toured the outdoor area (backyard). The yard is fully fenced. LPA observed hot tubs that is covered, this hot tub did not have the proper lock. (off limits)

The home has a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detector, first aid kit and telephone. The home has a pull down fire alarm that has been approved by the Pleasanton Fire Department. There are age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.



See 809-C
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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 3
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: WU, GUIZHEN
FACILITY NUMBER: 015700453
VISIT DATE: 04/20/2023
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Applicants completed the 16-hour Preventative Health training which includes EMSA approved CPR and first aid, one hour of Child Care Nutrition and Lead Poisoning. Applicant has documentation maintained for Measles, Pertussis Immunizations, and Tuberculosis (TB) clearance. Applicants has Criminal Record statement and Child abuse Index Clearance. Applicants has submitted proof of ownership of home to CCLD. CPR/First Aide expires on 07/16/24. Mandated reporter training completed on 03/16/23 and 12/15/22.

Discipline policy was discussed, and Applicants stated they will talk to the child and calm child down. Applicants understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children in Bedroom 1 on the main level of the home. Supervision of children, capacity options, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Disaster drills must be practiced once every six months and documented. Per applicant will not transport children.

LPA discussed the safe sleep regulations with applicants 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 applicants 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.

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: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: WU, GUIZHEN
FACILITY NUMBER: 015700453
VISIT DATE: 04/20/2023
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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 platform.

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. The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com. CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Applicants has been granted a license to begin operating as large Family Child Care home. License effective 04/20/2023. Fire clearance effective 04/10/2023 by the Livermore/Pleasanton Fire Department.

Exit interview conducted and report was reviewed with the applicant Guizhen Wu.

LPA reviewed with applicants the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Entrance Checklist was provided to the applicant.

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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