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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002505
Report Date: 08/11/2022
Date Signed: 08/11/2022 04:16:51 PM

Document Has Been Signed on 08/11/2022 04:16 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:DENG, QIXIAFACILITY NUMBER:
384002505
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Deng QixiaTIME COMPLETED:
04:30 PM
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On August 11, 2022, Program Analyst (LPA) Van performed an unannounced mandated annual inspection and met with Licensee Deng Qixia. LPA explained the objective of the inspection and was granted access to the property by the Licensee. Three children are present today with Licensee and her helper. The Licensee complies with the licensing capacity and limits today. All adults who live or work in the house have a criminal background check. The Licensee owns the home. Day Care Areas are a living room, one bedroom for a nap, and a bathroom. Off Limit Areas are one bedroom upstairs, kitchen, the entire ground level, and the upper portion of the backyard. During the inspection, the Licensee wishes to add the lower backyard portion to her license. LPA inspected the lower portion of the backyard and found the area clean, safe, and has an age-appropriate play structure for children. The lower backyard is approved as daycare today. All off-limit areas have been appropriately blocked off from the children. According to the Licensee, when a child displays illness, the Licensee will separate and have the child wait in the hallway while contacting the parent to take them up. The days and hours of operation are Monday through Friday, 8:00 am to 6:00 pm.

LPA examined and inspected the inside and outside of the home for health and safety concerns. The childcare environment is clean and organized, with age-appropriate activities, books, and play materials. The home has proper heating, lighting, and ventilation and is free of defects or situations that risk children's care.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DENG, QIXIA
FACILITY NUMBER: 384002505
VISIT DATE: 08/11/2022
NARRATIVE
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The house has a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a functional phone. The facility has a fully stocked first aid kit available for children. LPA observed a baby crib in the nap room, which is in good working order with fitted mattresses and bedsheets. LPA advised the Licensee that no toys, pillows, or anything else should be hung over the cribs/playpens. A child-proof cover protects every unused electrical outlet. Poisons, detergents, and cleaning agents are kept out of reach of children. The facility has no bodies of water. The play structures and toys in the backyard are age-appropriate, in excellent shape, and free of loose components or hazards. A baby gate was observed at the bottom of the steps that prevented children from accessing the off-limit upper portion of the yard. According to the Licensee, there were no firearms, weapons, or pets on the premises and no baby walkers, bouncers, or similar equipment in the daycare. The Licensee is informed that smoking is not permitted in family child care facilities.

According to the Licensee, fire and earthquake drills are conducted every other month. The last drill took place on July 29, 2022. All drills were logged correctly and documented. The facility provided snacks, breakfast, lunch, and dinner to children.

During the inspection, LPA reviewed all children's records who were present. The Licensee maintains thorough records for all children in their care, including vaccination records and Parental Rights forms. LPA noted that each kid had a complete emergency information card that included the child's full name, phone number, and the location of a parent or authorized person who may be called in an emergency. The name and phone number of the child's doctor and the parent's permission for the Licensee to consent to emergency medical care. The Licensee and helper kept up with their immunizations, Mandated Reporter Training AB 1207. The facility has valid daycare liability insurance through DCI. Pediatric CPR/First Aid for Licensee is valid until 3/2024. The Licensee posted all required paperwork, such as the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DENG, QIXIA
FACILITY NUMBER: 384002505
VISIT DATE: 08/11/2022
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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.

LPA discussed the safe sleep regulations with the Licensees and the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the 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 Family Child Care Homes Section 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: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensees were informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA-certified lead poison training if applying for a change of location or capacity change to an existing license.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: DENG, QIXIA
FACILITY NUMBER: 384002505
VISIT DATE: 08/11/2022
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LPA encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee Deng Qixia read and signed the report. During today's inspection, no deficiencies were discovered. Copy of the report and notice of site visit was given to the Licensee. LPA reminded the Licensee a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
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