073407507-4-1-2025-52-CC-MPRE-DFBSV8-20250401141219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407507
Report Date: 04/01/2025
Date Signed: 04/01/2025 02:12:35 PM

Document Has Been Signed on 04/01/2025 02:12 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:	ZENG, QI		FACILITY NUMBER:	073407507
ADMINISTRATOR/ DIRECTOR:	ZENG, QI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 786-8780
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 1	CENSUS: 1	DATE:	04/01/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:50 AM
MET WITH:	Qi Zeng		TIME VISIT/ INSPECTION COMPLETED:	02:09 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 4/1/2025 at 11:50am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Qi Zeng for an Unannounced Annual/Random Inspection. Present during the inspection was the Licensee and one (1) preschool age child. Licensee lives in the home with her husband and their minor child. Licensee’s home was toured for a health and safety inspection. The facility operates 9:00am – 5:00pm, Monday – Friday. ON LIMITS AREA: Living room, family room, dining area (used as a play area), downstairs half bathroom and kitchen OFF LIMITS AREA: Entire second floor, downstairs bedroom, downstairs laundry room, garage and backyard ISOLATION AREA: Family room At 12:25pm LPA observed the backyard of the home where the two (2) honeybee boxes are. LPA observed active bees around the boxes in the backyard. LPA asked Licensee if a gate could be placed in between the bee boxes and the area of the yard where children would play. Licensee stated that she will continue to have the backyard off-limits to children. Licensee stated she will continue to use the nearby neighborhood park for outside play. LPA informed Licensee that for the safety of the children the backyard must be permanently placed off-limits while the boxes are outside. 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. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee currently only provides meals when requested. Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

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: ZENG, QI	FACILITY NUMBER: 073407507
	VISIT DATE: 04/01/2025

NARRATIVE

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All food that is brought from the children’s home will be properly labeled and stored. Licensee uses child sized tables and chairs for meal times. All materials used for eating was observed to be well maintained, free from defect and in proper working order. There are no infants in care. LPA observed five (5) cribs that could be used for infants in the family room. All cribs were observed to be clean and free from defects. All off-limit areas in the home are made inaccessible with locks and gates. Licensee stated she does not transport children, there are no firearms, and no pets in the home.

The home has one (1) fully charged 2A10BC fire extinguisher in the dining room next to a bookshelf. There is one (1) working smoke detector in the hallway and above the entrance to the downstairs bedroom. LPA observed the carbon monoxide detector that used to be in the hallway had been removed. LPA asked Licensee where it was, and Licensee stated that she did not know where it currently was but would make sure it is replaced. The electric fireplaces in the living room and family room are locked making them no harm to the children in care. The staircase leading to the second floor is gated making the stairs and the second floor 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 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 has expired as of 5/7/2024 (See LIC809D). LPA reminded Licensee that CPR & First Aid training must be renewed every two years. LPA informed Licensee that she must register for a training by Monday, 4/7/2025 and send LPA a copy of the registration. Licensee’s Mandated Reporter training is complete and expires 7/1/2025. Fire/disaster drills have not been conducted and documented, as the only child enrolled in care started on 3/12/2025. Licensee has not had children in care for about nine months. LPA informed Licensee that a drill must be conducted within six months of the child’s enrollment date. LPA verified all adults living in the home have obtained a criminal record clearance.

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NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

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: ZENG, QI	FACILITY NUMBER: 073407507
	VISIT DATE: 04/01/2025

NARRATIVE

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All required forms are currently posted by the front door of the home. LPA obtained the children’s files, and facility files. All files were complete.

Deficiencies cited during LPAs inspection

Expired EMSA approved CPR & First Aid training

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.

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NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

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: ZENG, QI	FACILITY NUMBER: 073407507
	VISIT DATE: 04/01/2025

NARRATIVE

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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 Qi Zeng, 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 Qi Zeng. Page 4 of 4

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/01/2025 02:12 PM - It Cannot Be Edited

Created By: Morgan Pringle On 04/01/2025 at 01:33 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: ZENG, QI	FACILITY NUMBER: 073407507
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee's EMSA approved pediatric CPR & First Aid training has expired as of 5/7/2024. 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: 04/07/2025
	Plan of Correction
1 2 3 4	Licensee must register for a CPR & First Aid training by end of day Monday, 4/7/2025 and send LPA proof of registration. Once training is complete, Licensee must send LPA proof of training completion. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Jason Jang
NAME OF LICENSING PROGRAM MANAGER:

	Morgan Pringle
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

LIC809 (FAS) - (06/04)

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