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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700250
Report Date: 04/05/2023
Date Signed: 04/05/2023 11:32:51 AM

Document Has Been Signed on 04/05/2023 11:32 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:SUN, XIAOHONGFACILITY NUMBER:
075700250
ADMINISTRATOR:SUN, XIAOHONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 507-2809
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/05/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Xiaohong SunTIME COMPLETED:
11:40 AM
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On April 5, 2023 at 9:30am, Licensing Program Analyst (LPA) Julia Placencia arrived announced for a Prelicensing/Change of Location Inspection. LPA met with applicant Xiaohong Sun. Also residing in the home is the applicant’s husband Jun Chen and son Kaiyuan Chen. All adults living in the home have proper fingerprint and TB clearances. The home was toured with the applicant to conduct a health and safety inspection. Applicant states the hours of operation for day care will be Monday through Friday, 7:00am to 7:00pm.

The home is single story, which consists of a kitchen, dining/family room, living room, three bedrooms, two bathrooms, garage and backyard with storage unit. The home is neat and clean with heating and ventilation for safety and comfort.

ON LIMITS: Living/Playroom, Hall Bathroom, Backyard Patio. The isolation area will be in the Foyer.

OFF LIMITS: Kitchen, Dining/Family Room, All Bedrooms including Master Bathroom, Garage, Gated Backyard Area beyond cement patio. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits.

The outdoor play area will be the cement patio in backyard, which is barricaded by a child proof fence. The yard also has a fence that surrounds the perimeter, and is free from defects or dangerous conditions. There are no pools, hot tubs or any other bodies of water. There are ample age appropriate toys and activities that were observed to be safe, clean and in good repair. The playroom has retractable gates at each entrance. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 2A10BC fire extinguisher which is located in the kitchen, and functioning carbon monoxide/smoke detector combination units throughout the home. First aid supplies are available. The home does not have a fireplace. Heater vents are located on the ceiling. Per applicant, there are no firearms in the home.
***Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SUN, XIAOHONG
FACILITY NUMBER: 075700250
VISIT DATE: 04/05/2023
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The applicant’s health and safety training has been completed, and includes the child nutrition and lead poisoning components. First Aid/CPR certificate is current, expiring on 11/6/24. A copy of the property tax statement has been reviewed and shows control of property. The applicant has provided proof of the required immunizations for daycare providers, and her mandated reporter training was completed on 3/18/23. Licensing forms pertaining to the children’s files and facility files were reviewed and discussed with the applicant.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.



LPA discussed the safe sleep regulations with applicant 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 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.

***Continued on LIC 809C...

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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: SUN, XIAOHONG
FACILITY NUMBER: 075700250
VISIT DATE: 04/05/2023
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On 02/02/2023, a fire clearance was granted to this facility by San Ramon Valley Fire Protection. All documents have been received for the change of location application. The applicant was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee shall comply with the capacity requirements for a small family child care home.

The following corrections are required before the home can be licensed:

  • Install child proof door latches on door knobs in hallway.

These corrections shall be submitted by providing photos within 10 days of this report. LPA may visit facility to confirm corrections have been complete.

Exit interview conducted with applicant Xiaohong Sun, and copy of report provided. This report shall remain on file for 3 years.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained. A fire/disaster drill must completed at least every six months and must be documented. Mandated reporter requirements also discussed. Applicant received copies of various pamphlets pertaining to child's safety and parent's responsibilities. Informed the applicant that all forms can be downloaded at www.ccld.ca.gov
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
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