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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004602
Report Date: 08/03/2022
Date Signed: 08/03/2022 12:19:25 PM

Document Has Been Signed on 08/03/2022 12:19 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:WANG LIM,MELANIEFACILITY NUMBER:
384004602
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
08/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melanie Lim WangTIME COMPLETED:
12:30 PM
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On August 3, 2022, Licensing Program Analysts (LPAs) Van and Garcia conducted an announced prelicensing inspection and met with the Applicant, Melanie Wang, and her husband. This inspection included a technical assistance inspection for COVID-19 guidance and support. Presently, the Applicant is caring for a minor son at home. The Applicant owns this three-bedroom two-level single-family home, and the property control document was submitted during the inspection. The upper level has two bedrooms and a bath. The ground has one bedroom and one bath. Per Applicant, the home residents are herself, her husband, and a minor child. Days and hours of operation are Monday - Friday, 8:00 am. to 5:30 pm. Daycare areas are the living room, dining, and bathroom on the upper floor. The off-limit areas are the kitchen, bedrooms #1 and #2 on the upper floor, the entire ground floor, and the garage. Per the Applicant, she plans to utilize the hallway area as an isolation for sick/ill children.

LPAs and the Applicant inspected the entire home for Health and Safety Hazards. The home is clean, orderly, and has sufficient lighting and ventilation. There are a variety of age-appropriate wooden toys and puzzles for the children. There are multiple imaginative play toys. All furniture and playthings were observed to be in good repair. The Applicant's home has a smoke detector installed and a carbon monoxide detector. During the inspection, fire alarms were tested and worked. All harmful objects, sharp objects, and toxins are stored out of reach of children and made inaccessible to children. All accessible cabinets had child safety locks installed, and all entry/exit points had child-proof gates. There are First Aid kits available for the children.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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: WANG LIM,MELANIE
FACILITY NUMBER: 384004602
VISIT DATE: 08/03/2022
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The bathroom is clean, and no cleaning products are stored there. The applicant states there are no pets in the home. There are guns at home. Gun and ammunition were observed stored and locked separately. All Electrical outlets have plastic covers. The fireplace is observed blocked off by a children's bookshelf. However, the bookshelf was not flushed against the fireplace. The Applicant states she will make some modifications and send proof of correction to LPAs. LPAs reminded the Applicant to conduct an emergency drill once every six months and document the drills. The Applicant was informed that NO baby walkers, exer-saucers, jumpers, bouncers, and any similar items to be used for children in care should be made inaccessible. The Applicant was also reminded that smoking is prohibited at the daycare.

Applicant plans to provide children with snacks, breakfast, and lunch. Per Applicant, she plans to purchase liability insurance for child care. LPAs informed the Applicant that if child care insurance is not purchased, each parent must be given the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant's Pediatric FirstAid CPR and Mandated Reporter Training are valid, and copies have been submitted to the Department.

LPAs discussed the safe sleep regulations with the Applicant 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. LPAs also informed the Applicant 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.

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

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
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: WANG LIM,MELANIE
FACILITY NUMBER: 384004602
VISIT DATE: 08/03/2022
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The 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

LPAs reviewed with the Applicant 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. The entrance Checklist was also provided to the Applicant.

License capacity and limitation were also reviewed with the Applicant. LPAs informed the Applicant that if care is provided to the 7th and 8th child, who must be school-aged, parent notification and landlord consent are required.

The Applicant was reminded 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. The Applicant was encouraged to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. The Applicant was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders through Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important licensed-related information about 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.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
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: WANG LIM,MELANIE
FACILITY NUMBER: 384004602
VISIT DATE: 08/03/2022
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Prior to licensure, the following issue must be addressed.
· Install a baby gate between the dining area and the entryway to the kitchen room.
· The heater and ventilation vent need to be screened.
· Install a bookshelf that barricades and must be flushed against the fireplace.

The report was reviewed and signed by the Applicant, Melanie Wang. Today's report, 8/3/2022, will be sent to the Licensee's email by the close of business on 8/3/2022. Confirmation of receipt is required.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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