Community Care Licensing

Document Has Been Signed on 09/27/2022 05:35 PM - It Cannot Be Edited

FACILITY NAME:	XIAO, YANG		FACILITY NUMBER:	414004502
ADMINISTRATOR:	XIAO, YANG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 544-8111
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Yang "Coco" Xiao		TIME COMPLETED:	05:45 PM

SUPERVISORS NAME: Cindy Interiano LICENSING EVALUATOR NAME: Catrina Quimbo LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022

FACILITY NAME: XIAO, YANG	FACILITY NUMBER: 414004502
	VISIT DATE: 09/27/2022

FACILITY NAME: XIAO, YANG	FACILITY NUMBER: 414004502
	VISIT DATE: 09/27/2022

Link to Parent Document Below:

FACILITY NAME: XIAO, YANG	FACILITY NUMBER: 414004502
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2022

Type A

Section Cited

CCR

102370(d)(1)

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in having H2, an uncleared individual directly working with and supervising enrolled children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/28/2022
	Plan of Correction
1 2 3 4	Licensee stated H2 has fingerprint clearance that licensee will transfer and associate to licensee's facility. Licensee stated if H2 does not have fingerprint clearance, H2 will go through live scan process by 09/28/2022.

Type A

Section Cited

CCR

102416.5(d)(1)

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record review and interview, the licensee did not comply with the section cited above. LPA observed 8 infants (under 24 months) and 2 preschool age children to be present in the home, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/28/2022
	Plan of Correction
1 2 3 4	Licensee is aware family child care home cannot operate with more than 4 infants at a time. Licensee will need to adjust children's schedule to meet capacity requirement of a large family child care home license. LPA to conduct follow up inspection to verify correction.

SUPERVISOR'S NAME: Cindy Interiano LICENSING EVALUATOR NAME: Catrina Quimbo LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022

Link to Parent Document Below:

FACILITY NAME: XIAO, YANG	FACILITY NUMBER: 414004502
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2022

Type B

Section Cited

CCR

102416(c)

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by not having proof of a valid, current, CPR certificate that is EMSA certified for either licensee or any helpers present during LPA's visit which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 10/31/2022
	Plan of Correction
1 2 3 4	Licensee stated licensee and all helpers present have a valid and current CPR certificate that is EMSA certified. Licensee to provide LPA proof of certification no later than 10/31/2022 by 5:00pm.

Type B

Section Cited

CCR

102423(a)(2)

(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by placing C1 in a high chair, awake and without food, in a napping area with other enrolled for approximately 30 minutes, which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 09/27/2022
	Plan of Correction
1 2 3 4	LPA advised H2 to remove C1 from high chair. H2 removed C1 from high chair during LPA's visit. LPA reminded licensee all staff need to be made aware children awake and without food cannot be placed in a high chair while other children are napping. LPA stated placing children in high chairs are considered restraints. Licensee stated she will discuss with all staff hired.

SUPERVISOR'S NAME: Cindy Interiano LICENSING EVALUATOR NAME: Catrina Quimbo LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022