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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407206
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:35:36 PM

Document Has Been Signed on 08/13/2024 02:35 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:PHONGSA, YUNLIFACILITY NUMBER:
073407206
ADMINISTRATOR/
DIRECTOR:		PHONGSA, YUNLIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 218-2388
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
08/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Yunli PhongsaTIME VISIT/
INSPECTION COMPLETED:
02:34 PM
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On 8/13/2024 at 12:25pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Yunli Phongsa for an unannounced annual/random inspection. Present during the inspection was the Licensee, her sixteen (16) year old son, one (1) school age child and three (3) preschool age children. Licensee lives in the home with her husband and son. Licensee’s home was toured for a health and safety inspection. The facility operates from 7:00am – 5:00pm, Monday – Friday.

ON LIMITS AREA: Living Room, Family Room, Kitchen, Dining Room, Nook, Downstairs Bedroom, Downstairs Bathroom, and Backyard
OFF LIMITS AREA: Entire 2nd Floor and Garage
ISOLATION AREA: Downstairs Bedroom

The facility is a two-story home owned by the Licensee. The inside of the home was observed to be clean with ample age-appropriate materials for the children’s learning and play. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children which was observed to be properly maintained and stored. All food that may be brought from the children’s home will be properly labeled and stored. All off limit areas in the home are made inaccessible with locks and gates. Licensee stated she does not transport children, there is one (1) cat, and no firearms in the home.



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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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: PHONGSA, YUNLI
FACILITY NUMBER: 073407206
VISIT DATE: 08/13/2024
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There is one (1) fully charged 3A40BC fire extinguisher located in the garage. There is one (1) working carbon monoxide detector at the bottom of the stairs across from the dining room. There are working smoke detectors in the living room, at the bottom of the stairs, in the downstairs bedroom and in the hallways between the bedroom and the garage. The staircase is gated making the second floor and the staircase inaccessible to the children in care. Licensee uses child sized tables and chairs in the kitchen for mealtimes. LPA observed two (2) cribs and child sized mats in the downstairs bedroom for napping. All napping materials were observed to be properly maintained and stored and is supplied by the Licensee. The home is equipped with central heat and air for proper ventilation.

The backyard is fully fenced. LPA observed multiple fruit trees and lots of small potted plants around the area. There are two (2) large storage sheds on the left side of the backyard that are locked and inaccessible to the children in care. Licensee stated she is not currently using the backyard until some of the potted plants are moved to create more space for the children in care. LPA did not observe any harmful 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 is complete and expires 5/5/2025. Licensee’s Mandated Reporter training expired on 6/24/2023. LPA reminded Licensee that the training is to be renewed every two (2) years. Licensee must complete the Mandated Reporter training by Friday, 8/16/2024 and will send LPA the certificate of completion. LPA obtained the fire/disaster drill log. The last drill recorded was 11/15/2023. License stated she did not have children in care in June 2024 when the next drill should have been conducted. Licensee stated the children present have just returned today. LPA informed Licensee that a fire/disaster drill will need to be conducted by Friday, 8/16/2024 and a copy of the documented drill must be sent to LPA as proof of completion. All adults living in the home have obtained a criminal record clearance. All required forms are posted on the wall in the living room. LPA obtained the children’s files, and facility files. All files were complete.

Deficiencies Cited During LPAs Inspection
· Licensee’s Mandated Reporter training expired on 6/24/2023
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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
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: PHONGSA, YUNLI
FACILITY NUMBER: 073407206
VISIT DATE: 08/13/2024
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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 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. 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.



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

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
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: PHONGSA, YUNLI
FACILITY NUMBER: 073407206
VISIT DATE: 08/13/2024
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During the exit interview, Licensee Yunli Phongsa, 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.

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 Yunli Phongsa.


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

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/13/2024 02:35 PM - It Cannot Be Edited


Created By: Morgan Pringle On 08/13/2024 at 01:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PHONGSA, YUNLI
FACILITY NUMBER: 073407206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Licensee's Mandated Reporter training expired on 6/24/2023 which is over a year fom todays inspection. Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/16/2024
Plan of Correction
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Licensee must complete the Mandated Reporter training by Friday, 8/16/2024 and must send LPA Pringle a copy of the certificate of completion as proof of correction.

Mandatedreporterca.com
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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