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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020985
Report Date: 06/14/2022
Date Signed: 06/14/2022 04:32:02 PM

Document Has Been Signed on 06/14/2022 04:32 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:XU & CHEN FAMILY CHILD CAREFACILITY NUMBER:
198020985
ADMINISTRATOR:XU, BING & CHEN, YINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 267-2267
CITY:ALAHAMBRASTATE: CAZIP CODE:
91803
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Applicant, Ying ChenTIME COMPLETED:
04:50 PM
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An announced Pre-Licensing Inspection was conducted by Licensing Program Analyst (LPA) Lilli Babcock. A risk assessment was conducted upon entry and appropriate COVID PPE was used. The purpose of today's visit is to inspect and evaluate facility for initial licensure, Applicant is applying for a Large Family Child Care Home. Present during this inspection were both Applicants, Applicants spouse/father, Applicants son and daughter and daughter’s friend.

Per applicant, family members residing in the home are 3 adults and 2 children. Per applicant, operation hours will be Monday to Friday, 8:30 AM to 6:30 PM. Applicant states that she will care for children from Birth - 12 years of age.

During this inspection the following was observed:
All areas identified on the facility sketch were inspected, including but not limited to, all off limit areas. This is a one-story home that consists of 2 bedrooms, 2 ½ bathrooms, kitchen, living room, dining room, laundry room, activity room, front yard, backyard (fenced) and detached garage.

Per applicant, the children will use 1 bathroom, living room, activity room, dining room, kitchen and backyard. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in area
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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: XU & CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198020985
VISIT DATE: 06/14/2022
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designated for children. The applicant states that there are no poisons on the premises.

Based on the Facility Sketch submitted, areas off limits to children and parents are: The front yard, 2 bedrooms, 1 1/2 bathrooms and garage. All areas inaccessible for children were observed to have a lock or childproof doorknob making them inaccessible for children in care. The door leading to the hallway with the 2 bedrooms and 1 ½ bathrooms contains a childproof doorknob and per applicant, the door will be shut during operating hours. The applicant understands that licensing staff may have access to off-limit areas during an inspection visit if necessary.

LPA Babcock observed the valve on the 2A10BC fire extinguisher to be in the green and indicates it is fully charged and was purchased on 4/24/22 as indicated on the receipt. Per applicant there are no fireplaces, firearms or weapons, or bodies of water on the premises and LPA did not observe any on this day. The only pets on the premises are fish in a tank in the living room. Smoke and carbon monoxide detectors were tested during the inspection and observed to be operable. There are first aid supplies available

The facility has a working cell phone and landline. LPA reminded Applicants that there must always be a working phone at the facility while children are in care. There are toys available for children. LPA observed sleeping arrangements in forms of 2 cribs and 4 cots.

The applicants state that they will provide food for children in care and are planning to apply for the food program.

Both applicants have completed the following required trainings: Preventative Health and Safety Training with Nutrition and Lead Components (taken on 4/18/21 and 4/13/22); Pediatric First Aid and CPR (both expire on 4/17/23) and Mandated Reporter Training (both expire on 4/7/24)..
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: XU & CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198020985
VISIT DATE: 06/14/2022
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The children will use the back yard for outdoor play, which was observed to be fenced and contain age-appropriate toys. There is a shed in the backyard that LPA observed to be made inaccessible with a key lock. Applicant states the shed will always be locked.

Applicant states that they will care for infants. LPA discussed the safe sleep regulations with Applicant Ying Chen.

At 4:00 pm, the following was discussed with the applicant:

· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: XU & CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198020985
VISIT DATE: 06/14/2022
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· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection of the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.
· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: XU & CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198020985
VISIT DATE: 06/14/2022
NARRATIVE
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· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

LPA consulted with applicant regarding COVID-19 health and safety guidelines on this date, applicant was provided forms to post via email. Licensing staff observed COVID- 19 postings posted in the day care on this date. During this inspection LPA discussed PIN 20-06 CCP, Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education. LPA reviewed with the applicant the Child Care Covid-19 Self-Assessment guide.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Applicant is seeking to provide care for 14 children, ages Birth -12 years old.
Based upon today’s inspection, there are no corrections pending at this time. The Family Child Care Home appears to meet Title 22 requirements. The application will be submitted for final review to the department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: XU & CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198020985
VISIT DATE: 06/14/2022
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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 in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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, licensee, or facility representative] 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.



LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.


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

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: XU & CHEN FAMILY CHILD CARE
FACILITY NUMBER: 198020985
VISIT DATE: 06/14/2022
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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 platform.

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.

Exit interview conducted and report was reviewed with the applicant Ying Chen.



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

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7