073409063-10-12-2023-02-CC-ILOA-CWJV7B-20231012161053

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409063
Report Date: 10/12/2023
Date Signed: 10/12/2023 04:11:01 PM

Document Has Been Signed on 10/12/2023 04:11 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	HU, GRACE		FACILITY NUMBER:	073409063
ADMINISTRATOR:	HU, GRACE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(917) 488-8977
CITY:	KENSINGTON	STATE: CA	ZIP CODE:	94708
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:44 PM
MET WITH:	Grace Hu		TIME COMPLETED:	04:17 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 October 12, 2023 at 12:44pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Grace Hu for the purpose of conducting an unannounced 1-year annual inspection. Present during today's inspection were the Licensee, two Fingerprint cleared Assistants - Kim Brae and Christopher Tran, and 7 preschool-age children. Operating days and times are Monday - Friday 9am-5pm. The Licensee only accepts preschool age children in her program. The home is a two-story house consisting of 3 bedrooms, 3 bathrooms, living room, dining area, kitchen, basement, backyard, and garage. On Limit Areas - are the living room, dining room, bathroom in the hallway to the right of the entry way, a side yard and backyard Off Limit Areas - are the entire upstairs, kitchen, basement, and garage which will be inaccessible by closed and/or locked doors, safety gates and visual supervision. ISOLATION AREA - next to the stairs in the living room The home is neat and clean with heating and ventilation for safety and comfort. The home has a fully charged 2A10BC fire extinguisher and a working combined smoke/carbon monoxide detector above the stairs. Licensee does not have Liability Insurance and was reminded to have parents of newly enrolled children to sign the "Affidavit Regarding Liability Insurance for Family Childcare Home" (LIC 282). Per the Licensee there are no firearms in the home. The Licensee has a current CPR/First Aid certificate which expires on February 23, 2024. The children bring their lunches from home. LPA observed plenty of toys and activities for the children. The Licensee uses the backyard and side yard for outdoor play, both are fully fenced. The side yard includes a play structure and a sand box. Access to the backyard and side yard is through the kitchen will only be used as a walkway to the backyard with adult supervision at all times. In the backyard there is a small water fountain that is commonly used for creating a relaxing living ********************************Report Continues on LIC 809-C*****************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HU, GRACE	FACILITY NUMBER: 073409063
	VISIT DATE: 10/12/2023

NARRATIVE

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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

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There were no deficiencies cited during today's visit.

Exit interview conducted and report was reviewed with Licensee Grace Hu.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HU, GRACE	FACILITY NUMBER: 073409063
	VISIT DATE: 10/12/2023

NARRATIVE

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space. Besides the small fountain there are no pools, hot tubs or any other bodies of water on the premises during today's inspection. LPA reviewed 5 children files and 3 staff files. All staff had a current mandated reporter certificate.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is 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

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 onFamily 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.

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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional

**********************************Report Continues on LIC809-C*******************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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