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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004511
Report Date: 12/15/2021
Date Signed: 12/15/2021 03:51:10 PM

Document Has Been Signed on 12/15/2021 03:51 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:LI, JIN ZHUFACILITY NUMBER:
384004511
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/15/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Li, Jin ZhuTIME COMPLETED:
02:00 PM
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On 12/15/2021, Licensing Program Analyst (LPA) Van met with the Licensee, Jin Zhu, Li, for a Pre-Licensing relocation inspection. The purpose of the inspection was explained and granted entry to the home by the Licensee. Present there are no children at the facility. The Licensee stated all children are on vacation. The Department received an application from the Licensee to request a relocation on November 5, 2021. Licensee's previous License number was 384002355.

Licensee, along with LPA, inspected inside and outside the home for health and safety Hazards. The Licensee owns this four-bedroom and one-bath home. Three bedrooms are located on the second level and one on the ground level floor, which the Licensee stated is used for storage only. The residence is Licensee, her husband, and two minor children. Days and Hours of operation are M -F, 8 am- 5 pm. Daycare areas are the living room, bathroom, and backyard. OFF limit areas are all four bedrooms, kitchen, dining area, and garage. All off-limit areas are appropriately barricaded. Two storage/toy shelves separated the living room and the off-limit dining area. The home is clean and in good repair with sufficient lighting and ventilation. The Licensee has installed multiple smoke and carbon monoxide combo detectors throughout the house. There is a fully charged fire extinguisher with a 3A-40-BC classification. LPA observed that the home has age-appropriate toys and equipment available for children in care. All harmful objects, including chemicals, disinfectants, and sharp objects, are inaccessible to children. There are no bodies of water in the facility. Per Licensee, there are no firearms, weapons, or pets in the home. Continued on the next page...
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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: LI, JIN ZHU
FACILITY NUMBER: 384004511
VISIT DATE: 12/15/2021
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LPA discussed with the Licensee all required posting (i.e., License, Notification of Parent's Rights, Notification of Personal Rights, and Emergency Disaster Plan). License is planned to use the wall by the door for posting. LPA provided COVID Technical Assistance to the Licensee, including handwashing, cough etiquette, and COVID-19 postings

Incidentals 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: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with the Licensee and discussed 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.

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. Continued on the next page...
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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: LI, JIN ZHU
FACILITY NUMBER: 384004511
VISIT DATE: 12/15/2021
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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.

Capacity limits of a Small and Large License were reviewed with the Licensee.



Prior to licensure, the following issues need to address.
- Open face heater in the bathroom required installation of screen or cover.
- Relocate the dryer in the hallway leading to the backyard to a different location to clear the hallway for children's access to the backyard.
- Postings requirement (e.g., Notification of Parent's Rights, Notification of Personal Rights, and Emergency Disaster Plan.)

Due to a computer issue during the inspection (Consistency check), the report was written using Microsoft Word and reviewed with the Licensee. The report was sent to the Licensee email at jinleeyu@yahoo.com by the close of business on 12/15/21, and Licensee's wet signature was requested. Confirmation of receipt is required.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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