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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002601
Report Date: 01/17/2023
Date Signed: 01/17/2023 12:16:29 PM

Document Has Been Signed on 01/17/2023 12:16 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, MIAOLING & LI, BAOLANFACILITY NUMBER:
384002601
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Miaoling Ding, Baolan LiTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Yee conducted an annual required inspection today. The purpose of the inspection was explained. LPA and Licensee toured the daycare areas. This is single family home. Present at the facility are both licensees Miaoling, Baolan, husband and 5 daycare children. The facility personnel summary report was reviewed with Miaoling and she said it is current. All adults living or working in the home have criminal background check on file. Current residents at the facility are Miaoling, Baolan, her father, mother-in-law, father-in-law, their 11, 9 years old children. The licensee provides day care from Monday to Friday between 8:00 AM to 5:00 PM.

Day Care Areas: living room, front room, kitchen, bathroom near the kitchen, sunroom, deck and back yard. The remaining areas are off limit. There are no body of water such as swimming pool, hot tub on the premises. Cleaning supplies, poisons and other chemicals are stored out of reach children. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house.

LPA reviewed the children's record and in ordered. Licensee's CPR, 1st aid card is current until 01-08-2025.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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, MIAOLING & LI, BAOLAN
FACILITY NUMBER: 384002601
VISIT DATE: 01/17/2023
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During Inspection:
-Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation. A blank form of Infant Sleep Log was provided.
-Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. Both licensees completed AB1207 on 04-27-2021, 02-07-2022.
-Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.

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 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. LPA 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.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
LIC809 (FAS) - (06/04)
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