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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101175
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:43:15 AM

Document Has Been Signed on 08/24/2022 11:43 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WEN, MIAOXIN & JESSE FAMILY CHILD CAREFACILITY NUMBER:
376101175
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/24/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jesse and Miaoxin WenTIME COMPLETED:
11:45 AM
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On 08/24/2022 at 9:35am, Licensing Program Analyst (LPA), Selina Siao conducted a pre licensing inspection with both applicants Jesse Wen and his wife Miaoxin Wen. The 4 bedroom, 2.5 bath 2 stories house was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 2A10BC, smoke and carbon detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The home does not have any bodies of water. Applicant stated that the home doesn't have any weapon. Applicants have an EMSA approved pediatric CPR and First Aid card that are current due to expire on 2/27/2024. Jesse Wen completed the 8 hours preventative health practice course on 03/13/2022 and Miaoxin Wen completed the 8 hours preventative health practice course on 07/10/2022. Co-applicant Miaoxin Wen completed the online mandated child abuse training on 06/23/2022. A review of the application and records on this date indicates that both applicants are the current adult residents at the home with the require TB clearances, caregiver background checks and child abuse clearances. Both Applicants has the required immunizations. Applicants rent the property and has provided a copy of their rental agreement.

Applicants will be using the following areas for childcare: living room, dining room, family room and bathroom. The home has a fireplace in the family room that is blocked off with a secured gate. Off limit areas: kitchen, garage and all of upstairs and there is a door knob cover for the garage door and a gate at the kitchen and at the bottom of the stairs to prevent children's access to the off limit areas. Outdoor area will be the fenced backyard and visual supervision is required when children are outside.

Applicants shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WEN, MIAOXIN & JESSE FAMILY CHILD CARE
FACILITY NUMBER: 376101175
VISIT DATE: 08/24/2022
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Applicants 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 applicants 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[applicants 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 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

LPA reviewed with applicants 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.

All unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WEN, MIAOXIN & JESSE FAMILY CHILD CARE
FACILITY NUMBER: 376101175
VISIT DATE: 08/24/2022
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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.

The following items shall be submitted to LPA via email or text within 10 days prior to granting a license:
  • Jesse Wen needs to take the online mandated child abuse training.
  • The home needs to have an operating carbon monoxide detector.

Exit interview conducted and report was reviewed with the both applicants.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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