<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409437
Report Date: 02/14/2025
Date Signed: 02/14/2025 11:19:46 AM

Document Has Been Signed on 02/14/2025 11:19 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:FAN, PEISHIFACILITY NUMBER:
073409437
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
02/14/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Peishi FanTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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 02/14/2025 at 9:15 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced case management – licensee initiated for Peishi Fan's small family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 2 children in care ( 2 infant children) and 3 children enrolled. Family members residing in the home are licensee only. Licensee have Criminal Record Clearance. Facility hours of operations are Monday - Friday from 6:00 AM - 6:00 PM.

Licensee completed her Pediatric CPR/First Aid certificate which expires 07/2025 and Mandated Reporter certificate which expires 07/2025. Licensee has documentation maintained for Measles, Pertussis Immunization's, Influenza Opt-Out statement for the current flu season. The licensee provided proof of control of property. There is a working telephone in the home. Fire clearance request was approved on 01/22/2025 by Inspector Chris Giddis of the Contra Costa County Fire Protection District.

This is a one story Home which comprises of 3 bedrooms, 2 bathrooms, Living Room, Kitchen, Dining room, Laundry Room, attached garage and backyard.
Areas on limits: Living Room, hallway bathroom, kitchen, dining room, first bedroom to the left, right area of backyard. Licensee will be utilizing the living room as the main room for her day care area.
Off-Limit Areas: 2 bedrooms including master bedroom, master bathroom, laundry room, center area of backyard with shed, and attached garage.
Isolation Area: 1st Bedroom to the left
The LPA toured all areas used by children during this visit.

Per licensee, there are no is firearm in the home. LPA observed a fully charged 3A40BC fire extinguisher, working dual smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. There are no stairs in the home. *CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FAN, PEISHI
FACILITY NUMBER: 073409437
VISIT DATE: 02/14/2025
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
26
27
28
29
30
31
32
*PAGE 2*

OUTDOOR SPACE: LPA toured the outdoor area. LPA observed a fully fenced and safe backyard for children in care. LPA observed age appropriate toys for children to play with. The right area of the backyard will be an on limits area for children in care. The center area of backyard will be off limit and made inaccessible for children in care. LPA observed a locked shed in the backyard that is in an off limit area. LPA did not observe any bodies of water in the backyard. Children will be using the backyard for outdoor activity. LPA discussed with licensee that there needs to be 100% supervision when outside of the facility. Licensee will not provide transportation for children and understands that children cannot be left alone, unattended in parked vehicles.

LPA discussed and reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours. All documents have been reviewed for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at:https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602. Licensees are to call and report injuries or unusual incidents within 24 hours of knowledge of occurrence. Licensees are to review the form (LIC 624B) to follow up in writing within 7 days of the injury/unusual incident.

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.


*CON'T ON PAGE 3*
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FAN, PEISHI
FACILITY NUMBER: 073409437
VISIT DATE: 02/14/2025
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
26
27
28
29
30
31
32
*PAGE 3*

On this date, 01/07/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Effective as of 02/14/2025, change of capacity application has been approved.

During today's inspection, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Peishi Fan. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3