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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019996
Report Date: 06/23/2022
Date Signed: 06/23/2022 11:20:54 AM

Document Has Been Signed on 06/23/2022 11:20 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WU FAMILY CHILD CAREFACILITY NUMBER:
198019996
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Xuemin WuTIME COMPLETED:
11:30 AM
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At 8:30 am Licensing Program Analyst (LPA) Lilli Babcock conducted an unannounced Case Management – Licensee Initiated visit to the above facility for the purpose of evaluating the Licensee’s request for a capacity increase from 8 to 14. Fire clearance for a capacity of 14 was granted on 6/10/22. A COVID risk assessment was conducted upon entry and appropriate COVID-19 Personal Protective Equipment was used during the visit. LPA met with Licensee’s Xuemin Wu and Yujun Wu, to whom the reason for the visit was explained. Per Licensee, there are 8 children currently enrolled. There were no children present upon arrival. The licensees were observed to be operating within the license capacity limitations.

The licensees state that 3 adults and 2 children currently live in the home. All adults living in the home have obtained a criminal record clearance.

This is a one-story home which consists of 4 bedrooms, 1 bathroom, kitchen, dining room, living room, detached garage, front yard, and fenced backyard.

Per licensee, areas off limits to children and parents include 3 bedrooms, garage, and front yard.

The children have access to kitchen, dining room, living room, one bathroom, one bedroom, and backyard which is fenced.


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WU FAMILY CHILD CARE
FACILITY NUMBER: 198019996
VISIT DATE: 06/23/2022
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Licensee’s guided analyst on a tour of the facility at 8:40 am. During this visit, all areas identified on the facility sketch that are accessible to children to use were toured and inspected. The following was observed:

Facility License, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the entry way of the home. A current children’s roster was available for review.

There is telephone service via a cellphone and landline. Hours of operation are Monday through Friday, 8:00 am – 6:00 pm. There is central air conditioning and central heating in the home. Licensee states there is not a fireplace in the home, and none were observed on this day.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Poisons are locked with a key lock in the garage. LPA advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 10/7/21, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 6/3/22.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WU FAMILY CHILD CARE
FACILITY NUMBER: 198019996
VISIT DATE: 06/23/2022
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The home is observed to be clean and orderly. There are first aid supplies available. There are age-appropriate toys available for children. Appropriate sleeping arrangements in form of a crib was observed.

Licensee states that she is currently caring for one infant, aged 23 months. LPA Babcock observed a sleep log for the infant.

Currently, children are using the back yard for outdoor play time. LPA observed outdoor yard has toys and other materials for children to play with.

Children’s records were reviewed, including emergency information and were observed to be complete.



Both Licensee’s records were reviewed and were observed to be complete.

The licensees have both completed training on preventive health practices including nutrition. Both licensees Pediatric First Aid and CPR expires on 6/12/24.

LPA observed that both Licensees have proof of immunization records and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file with expiration on 4/11/24.

LPA issued an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review to the licensee which documents staff and children’s files reviewed during this inspection.


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WU FAMILY CHILD CARE
FACILITY NUMBER: 198019996
VISIT DATE: 06/23/2022
NARRATIVE
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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Per Licensee, there is a turtle on the premises, located in an off-limit bedroom.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, trampolines, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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, 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.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WU FAMILY CHILD CARE
FACILITY NUMBER: 198019996
VISIT DATE: 06/23/2022
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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.

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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.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No citations were being issued today. The capacity increase request for a Large Family Child Care will be submitted for review. Once a capacity increase is issued, the Licensees are required to adhere to the terms and limitations as stated on the license.



Exit interview conducted and report was reviewed with the licensee Xuemin Wu.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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