334845740-1-30-2024-09-CC-TDIP-CZYUSJ-20240130145025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845740
Report Date: 01/30/2024
Date Signed: 01/30/2024 02:50:38 PM

Document Has Been Signed on 01/30/2024 02:50 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	HSIAO FAMILY CHILD CARE		FACILITY NUMBER:	334845740
ADMINISTRATOR:	WEI-HSIN HSIAO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 268-0906
CITY:	EASTVALE	STATE: CA	ZIP CODE:	92880
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	01/30/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Wei-Hsin Hsiao		TIME COMPLETED:	03:15 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	On 01/30/2024 at 11:00 AM, Licensing Program Analysts (LPAs) Elyse Jones and Tiffanie Diep met with Licensee Wei-Hsin Hsiao for the purpose of an unannounced annual inspection. Entrance Checklist (LIC 126) was provided to Licensee, and Licensee guided LPAs on a tour of the home. Licensee’s primary language is Mandarin and LPAs used nonverbal communication during the inspection. Licensee was able to speak and understand limited English. Licensee provided proof of control of property. LPAs observed seven children present in the home with Licensee. Licensee's operating hours are Monday through Friday from 8:00 AM to 6:00 PM. LPAs verified that annual fees are current. All individuals subject to a criminal record review have obtained a criminal record clearance. 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 five 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. LPAs reviewed five children's files, and LPAs observed emergency information and required immunization records were on file. LPAs observed a current roster and documentation that a fire drill is conducted at least once every six months. LPAs verified Licensee's immunization records were available in the facility file. Mandated Reporter Training certificate expired on 10/19/2021. The training is not offered in Chinese at this time. Current EMSA pediatric CPR and first aid certification was verified and expires on 05/06/2025. Continues on 809-C

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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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Document Has Been Signed on 01/30/2024 02:50 PM - It Cannot Be Edited

Created By: Tiffanie Diep On 01/30/2024 at 12:44 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HSIAO FAMILY CHILD CARE	FACILITY NUMBER: 334845740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above as Licensee did not ensure a knife and multiple Lysol toilet bowl cleaners with bleach were inaccessible which poses an immediate health, safety or personal rights risk to children in care.
	POC Due Date: 01/31/2024
	Plan of Correction
1 2 3 4	Children were playing outside at the time of inspection. Licensee placed the knife and cleaners in locations that were inaccessible to children in care during the visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Aaron Ross

LICENSING EVALUATOR NAME:

Tiffanie Diep

LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HSIAO FAMILY CHILD CARE	FACILITY NUMBER: 334845740
	VISIT DATE: 01/30/2024

NARRATIVE

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Continued from 809 (Page 2)

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas in the home include the master bedroom and bathroom, laundry room, and garage. Licensee acknowledged that children may never enter the off-limits areas. LPAs observed the required postings and a working phone. LPAs observed a 2A10BC fire extinguisher meets regulations and verified both smoke and carbon monoxide detectors were functional. LPAs toured the kitchen area and observed a knife located on the drying dish rack on the kitchen counter. Children were playing outside at the time of the observation. Licensee placed the knife away in a location inaccessible to children in care. LPAs observed a restroom and observed multiple bottles of Lysol toilet bowl cleaners with bleach underneath the cabinets that were not secured with latches. Licensee placed the cleaners in another cabinet that were inaccessible to children in care. LPAs observed the family and living rooms with age-appropriate toys for children. Licensee stated there are no weapons in the home. LPAs did not observe a fireplace in the home. The outdoor play area was inspected and is surrounded by a brick wall. LPAs walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPAs did not observe bodies of water on the premises.

LPAs 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. LPAs 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. LPAs discussed the requirement to check and log infant sleeping every 15 minutes for infants under 24 months and to maintain a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/resources/child-care-centers/.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HSIAO FAMILY CHILD CARE	FACILITY NUMBER: 334845740
	VISIT DATE: 01/30/2024

NARRATIVE

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Continued from 809-C (Page 3)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, 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.

Based on LPAs’ observations, a deficiency is being cited on the attached LIC 809-D. LPAs Elyse Jones and Tiffanie Diep informed the licensee, Wei-Hsin Hsiao, that this report dated 01/30/2024 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed Licensee to provide a copy of this licensing report dated 01/30/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgment of Receipt of Licensing Reports (LIC 9224), or other written statement, must be placed in the child’s file for verification.

An exit interview was conducted and report was reviewed with the licensee, Wei-Hsin Hsiao, using the Department’s interpretation services. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPAs completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. A copy of Appeal Rights (LIC 9058) in Chinese were provided to Licensee.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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