434416311-4-7-2021-07-CC-YHUG-BZUPU3-20210407113648

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416311
Report Date: 04/07/2021
Date Signed: 04/07/2021 11:38:33 AM

Document Has Been Signed on 04/07/2021 11:38 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LI, TINGXIU		FACILITY NUMBER:	434416311
ADMINISTRATOR:	LI, TINGXIU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 809-6806
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	TingXiu Li		TIME COMPLETED:	12:00 PM

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Licensing Program Analyst (LPA) Oscar Huang conducted an announced prelicensing tele-inspection via video conference call (FaceTime) with Tingxiu Li, Applicant. The purpose of today's tele-inspection: address the Application for a Large Family Child Care Home license that the Applicant submitted to the Department on March 05, 2021.

The adults that reside in the home is applicant only. LPA was aware that Applicant has worked with a large family Child Care since June, 2019, and a letter of service statement was submitted from the facility licensee. Days and hours of operation will be Monday - Friday from 8:00 AM to 6:00 PM. Applicant has completed her Preventative Health and Safety Child Care Training which includes an hour of nutrition & lead poisoning prevention on 02/13/2021, and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 02/2023. Applicant leases the home and a copy of the lease agreement is on file, as well as the Property Owner/Landlord Notification. LPA reminder Applicant if she did not purchase liability insurance, she will need to issue affidavit regarding liability insurance for her Family Child Care Home to the parent of child in care.

The Applicant agreed to give LPA a tour of the home (indoor/outdoor) via FaceTime during today's tele-inspection. The entire home was inspected for health and safety hazards. LPA observed no stairs inside the home. The main area of the home is used for the day care are Bedroom #4 (napping), Living Rooms #1 & #2, Room #1, Bathroom #1, Foyer/Dinning Room. LPA observed no fireplace. Off limit areas inside the home: Bedrooms #1, 2, & 3, Kitchen and Garage. LPA observed a fully charged 3A40BC fire extinguisher, at least one functioning combined smoke and carbon monoxide detector, fenced backyard, and no bodies of water. Off limits outdoor are areas marked as green areas. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Applicant states that there are no weapons, and no pets. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPA reminded licensee that smoking, drop side cribs, and baby walkers, bouncers, excer-saucers, jumpers etc. are not allowed in Family Child Care Homes. Applicant was advised to keep temperature within 68-85 degrees.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LI, TINGXIU	FACILITY NUMBER: 434416311
	VISIT DATE: 04/07/2021

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A review of staff records on today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.

LPA discussed Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicant has completed her training on 02/15/2021 and her certification is on file.

Forms of discipline were discussed with Applicant. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

LPA reviewed safe sleep policies for the infants with the Applicant and provided "A Child Care Provider's Guide to Safe Sleep & Individual Infant Sleeping Plan (LIC 9227) and included the recent released PIN 20-24-CCP. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing.

LPA discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPA also discussed AB 2231: Civil Penalty Updates effective July 1, 2017 with Applicant. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. LPA discussed SB 792 Immunization Requirement with Applicant. LPA observed appropriate records and physician notes for immunization against measles, pertussis, and influenza for Licensee in file. Incidental Medical Services (IMS) were discussed with Applicant. Applicant is not providing IMS at this time. Applicant will submit a plan of operation for IMS if in the future they provide any IMS to a child in care.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LI, TINGXIU	FACILITY NUMBER: 434416311
	VISIT DATE: 04/07/2021

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LPA reviewed COVID-19 infection prevention guidance & self-assessment with Applicant including the plans in place to protect and to support staff &children, as well as essential protective equipment and supplies, cleaning & hygiene implementation, arrival procedures, health screening & social distancing practices and meal times.

LPA advised Applicant that beginning January 1, 2019, AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

A fire clearance approval from the San Jose Fire Department was granted on 03/31/2021: (Rooms accessible to children include: Bedroom #4 (napping), Living Rooms #1 & #2, Room #1, Bathroom #1, Foyer/Dinning Room and Outdoor Playground. Off limits: Bedrooms #1, 2, & 3, Kitchen, Garage, & Outdoor where marked as Green Areas.)

The Applicant was informed that due to the current COVID-19 pandemic and "Stay At Home" Order, today's report (Facility Prelicensing Evaluation Report - LIC809 & LIC809Cs) will be emailed to the Applicant, Tingxiu Li <littlestarsanjose@gmail.com> with "Read Receipt" notification. The Applicant understands that her response to the email is considered an acknowledgement of "receipt" of today's report.

LPA conducted an exit interview and advised the Applicant that her large Family Child Care Home license is now pending on receiving the following item and management approval:

1. Pre-Licensing Readiness Guide - Family Child CAre Home (LIC 9217)

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC809 (FAS) - (06/04)

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