015700498-9-6-2023-52-CC-JSAI-CVEPM9-20230906112558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700498
Report Date: 09/06/2023
Date Signed: 09/06/2023 11:26:08 AM

Document Has Been Signed on 09/06/2023 11:26 AM - 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:	LU, HE		FACILITY NUMBER:	015700498
ADMINISTRATOR:	LU, HE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 887-5809
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	09/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant, LU HE		TIME COMPLETED:	11:50 AM

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Licensing Program Analyst (LPA) Jyoti Saini conducted a scheduled pre-licensing inspection and met with Applicant He, Lu. Applicant lives in the Rented house with her husband and two minor children. The house is double story house consists of 3 bedrooms including Master bedroom attached bathroom ,two bathrooms, family room, living room, kitchen, dining room, laundry, backyard and garage. Per applicant, family childcare’s operating hours will be Monday- Friday, 8:30am -6:00pm.

ON LIMIT AREAS are family room( main day care),bathroom #1 (downstairs),dining area, fenced area of the backyard and living room ( walk through to the backyard only)

OFF LIMIT AREAS: entire second floor, laundry room( downstairs) living room, kitchen, and garage.

The home appears to be neat and clean with heating and ventilation for safety and comfort. The ISOLATION AREA will be the living room. All off limit areas are properly barricaded. The home has a working smoke and carbon monoxide detector, a working telephone, and a fully charged Fire Extinguisher. There are no pools, hot tubs, or any other bodies of water on the premises. All hazardous materials and toxins are kept out of the reach of children. The applicant will be providing snacks, breakfast and lunch. Applicant states discipline policy is redirection. Per Applicant, she may or may not purchase liability insurance, applicant was advised to use form, the Affidavit regarding liability insurance for FCCH. Applicant was also advised to conducts fire/disaster drills once every six months, and to log the date and time of the drill. LPA discussed safe sleep guidelines and 15 minutes check requirements. Applicant's First Aid/CPR certificate expires in 5/2025. Applicant has taken Mandated Reporter training. Applicant is reminded of NO walker, exersaucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. Smoking is prohibited in family childcare homes. The Applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LU, HE	FACILITY NUMBER: 015700498
	VISIT DATE: 09/06/2023

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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Applicant rents the home and provided proof of control of property.

APPLICANT RENTS THE HOME AND HAS LANDLORD CONSENT: The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

APPLICANT KNOWS PROSPECTIVE CLIENTS WILL NEED IMS:
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

Safe Sleep :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 [applicant, licensee, or facility representative] 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.

Applicants was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LU, HE	FACILITY NUMBER: 015700498
	VISIT DATE: 09/06/2023

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MyChildCarePlan.org-- Applicants were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Subscribe to CCLD important information.
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.

Upon arrival, LPA observed the applicant and her helper providing care to the two infants before being licensed, resulting in violating Title 22 regulations.

prior to Licensure:

-Disenroll the children to whom the care is being provided.

-required posting.
-Manager's approval is required.

Exit interview conducted and report was reviewed with the applicant, Lu He.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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