304313993-3-16-2022-06-CC-KDEI-CCKT7V-20220316142922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313993
Report Date: 03/16/2022
Date Signed: 03/16/2022 02:29:32 PM

Document Has Been Signed on 03/16/2022 02:29 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ZHANG, XIWEI		FACILITY NUMBER:	304313993
ADMINISTRATOR:	ZHANG, XIWEI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 245-9383
CITY:	IRVINE	STATE: CA	ZIP CODE:	92620
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/16/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Applicant Ms. Zhang, Xiwei		TIME COMPLETED:	02:45 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	Licensing Program Analyst (LPA) Desai, Ketki conducted an announced in-person Pre-Licensing inspection for a new Large Family Child Care home. Applicant has been a Large Day care provider since 2013, qualifying her to obtain a license for a Large home . LPA met with the applicant Ms. Zhang, Xiwei who provided a tour of the new home. It is a Relocation . A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office. The applicant is requesting a Large family childcare home license. Per applicant, operation hours will be Monday to Friday 8:30 AM to 5:30 PM and care and supervision shall be provided to children ages 1-5 years only ( Preschool age only) All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story home with 4 bedrooms, 4 bathrooms, Loft area, living area, 2 kitchen, dining area, laundry room, open back yard with 2: side yards and an attached garage. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone. Ventilation and heating. The home has a central air and heating system and the unit is installed in the side yard , which in the off limit area. There is a stairway in the home leading to the second level of the home and it has a child safety gate barrier is installed at the beginning of the stairway. There is one fire place in the living area with a sealed mesh barrier across it and a couch in front making it inaccessible to children. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZHANG, XIWEI	FACILITY NUMBER: 304313993
	VISIT DATE: 03/16/2022

NARRATIVE

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Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has designated entire second level of the home, (three bedrooms/ three full bathrooms / Loft area/laundry room) and on the first level :One bedroom / 2 kitchen areas with the attached garage on the first level as off-limits areas. There is a child safety gate installed on the stairway, making the second level inaccessible. Home has two kitchen areas, the main kitchen is open adjoining the dining area, all the cabinets have child safety locks installed making it inaccessible to children. The second kitchen is across the garage door (access into the home), all the cabinets in the second kitchen area has safety locks installed and garage door and the bedroom door have safety latches installed on the handle bar making them inaccessible to children. There are no sharp items or knives on the kitchen counter, they are locked in the cabinet. Side yards and part of backyard have a fencing across the covered patio area, making the other sides of the back and side yard inaccessible to children. Dining area is open, children shall access the covered patio area through the sliding door in the dining area.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

The applicant shall use the Cell phone for Day care activities and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation. Applicant was informed and understands the home is to be free from smoking during hours of operation.

Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Applicant has designated the living room, one full bathroom, large passage area and the covered patio area for Day care activities. The children shall enter through the main door of the home into the large passage area, leading into the living area the designated Day Care room. The designated Child Care room was observed to have age appropriate toys, arts and craft materials, books and educational items including age appropriate furniture. Children shall nap in this area. Children shall nap on small mattress pads, linens and blankets shall be provided by the parents and applicant does have additional linens if needed. No Infant care is being provided by the applicant.

Upon entrance through the designated main door of the home applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines, upon entrance temperatures shall be checked, hands shall be sanitized, before children are guided into the designated day care areas. (2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZHANG, XIWEI	FACILITY NUMBER: 304313993
	VISIT DATE: 03/16/2022

NARRATIVE

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Applicant has set up a sanitizing station on top of the shoe storage cubby. The passage area is wide and open for children to engage in indoor activity.

Applicant shall provide AM/ PM snacks, lunch shall be offered as an option if agreed by the parents and if food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

The bathroom is located on the left side of the passage area, (next to the bedroom) it has toddler potty chair along with a step stool, there is cabinet under the sink with a child safety latch. The children's bathroom was observed to be safe and free of hazardous items.

OUTDOOR PLAY AREA: Applicant have designated the covered patio area only for outdoor activities for enrolled children. Applicant is in process of installing a proper barrier surrounding the covered patio area making the part of the back yard and side yards inaccessible to children. The backyard is completely fenced covered with concrete flooring. Outdoor play equipment's are arranged under the shaded area. Applicant has placed a soft padded mat upon the concrete flooring.

There are no firearms, weapons, or bodies of water or pets in the home.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant has mounted the Fire extinguisher inside the second kitchen wall, the new Fire alarm system has been installed and approved by the Fire authorities during the recent inspection.

Applicant have completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 7/31/2023 There are first aid supplies available.

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 certification, TB clearance along with a valid criminal record clearance associated to the facility license.
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. (3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZHANG, XIWEI	FACILITY NUMBER: 304313993
	VISIT DATE: 03/16/2022

NARRATIVE

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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. Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Large Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that being a Large Family Child Care Home, and with an assistant provider, may provide care for more than 12 and up to 14 children when one child is enrolled in and attending kindergarten (including transitional kindergarten) or elementary school, and another child is at least six years old, and no more than three infants are in care.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

Fire clearance approval has been received from Orange County Fire Authority on 3/3/2022 with a specific note : No use of Second level and Garage.

The facility at the time of Pre-licensing inspection is not in compliance for a (Large Family Child Care Home) with Title 22 Regulations.
Following correction is needed before the final approval.
(1) Installation of a proper safety barrier across the covered patio area, making the part of the back yard and side yards inaccessible to children.

The following items were discussed with the Applicant during the Exit interview.

Criminal Record Statement : Applicant Ms. Zhang, Xiwei 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. (5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZHANG, XIWEI	FACILITY NUMBER: 304313993
	VISIT DATE: 03/16/2022

NARRATIVE

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Safe Sleep :LPA discussed the safe sleep regulations with Applicant Ms. Zhang, Xiwei 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 Ms. Zhang, Xiwei 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

Exit Interview

Exit interview conducted and report was reviewed with the Applicant Ms. Zhang, Xiwei.

LPA reviewed with Applicant Ms.Zhang, Xiwei 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.

Entrance Checklist was provided to the applicant.

Subscribe to CCLD important information

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 license-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.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC809 (FAS) - (06/04)

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