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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002685
Report Date: 02/11/2022
Date Signed: 02/11/2022 04:47:10 PM

Document Has Been Signed on 02/11/2022 04:47 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:HUANG, CAI LIFACILITY NUMBER:
384002685
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Cai Li HuangTIME COMPLETED:
04:45 PM
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On February 11, 2022, Licensing Program Analyst (LPA), Van, conducted an unannounced required annual inspection and met with Licensee Cai Li Huang. The purpose of the inspection was explained and granted entry to the home by the Licensee. There are two preschool-age children in care with Licensee today. All adults living or working in the home have a criminal background clearance on file. Daycare areas are on the second floor, including the living room, bedroom next to the living room, kitchen/dining area, bathroom, and ½ of the backyard. Off limit areas are the other two bedrooms on the back and the bathroom next to the kitchen on the second floor, the whole ground level, the garage, and the other ½ of the backyard. The operation hours are 8:00 am – 5:45 pm, Monday - Friday. Per Licensee, when a child shows signs of illness, the Licensee will separate and have the child waiting in the daycare bedroom while contacting the parent to pick up. LPA and Licensee inspected the daycare areas for health and safety hazards during the inspection. LPA observed the following: The daycare area is clean, orderly, and equipped with safe, age-appropriate toys and equipment. LPA observed each child has individual storage space for their belongings. The home has adequate lighting ventilation and is free from defects or conditions that endanger children in care. The daycare has a working smoke alarm, carbon monoxide detector, and a fully charged fire extinguisher. First aid supplies are available for children. Poisons, detergents, cleaning compounds are inaccessible to children. The backyard is observed to be fenced, clean, and has age-appropriate toys and outdoor equipment are in good condition. Licensee has artificial grass installed underneath the play structures to absorb children's falls. The Licensee had posted all the required forms, such as facility License, Notification of Parent's Rights, Earthquake Preparedness checklist, and Notification of Personal Rights. Per Licensee, there are no firearms, weapons, or pets.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2022
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: HUANG, CAI LI
FACILITY NUMBER: 384002685
VISIT DATE: 02/11/2022
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The Licensee states she provides breakfast, lunch, dinner, morning and afternoon snacks to children. LPA observed no pools, spas, or other bodies of water on the premises. Licensee states Fire and Earthquake drills are conducted every other month, and the last drill was conducted on 1/20/2022. The next anticipated drill will be 3/20/2022. During the inspection, LPA reviewed records of the two children present. LPA observed each child has a complete emergency information card with the child's full name, telephone number, and location of a parent or other responsible adult to be contacted in an emergency. The name and telephone number of the child's physician and the parent's authorization for the Licensee or registrant to consent to emergency medical care. Licensee has a record of immunization and valid Pediatric FirstAid & CPR (CPR is valid until 5/9/2023. Mandated Reporter training is valid until 3/6/2023.

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 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.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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: HUANG, CAI LI
FACILITY NUMBER: 384002685
VISIT DATE: 02/11/2022
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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was 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 Licensee. 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.

LPA encouraged the Licensee to frequently visit our 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.

The report was reviewed and signed by the Licensee, Cai Li Huang. No deficiencies were observed in today's inspection. Today's report, 2/11/2022, and notice of site visit will be sent to the Licensee email by the close of business on 2/11/2022. Confirmation of receipt is required, and a notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
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