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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416456
Report Date: 06/15/2021
Date Signed: 06/16/2021 09:53:06 AM

Document Has Been Signed on 06/16/2021 09:53 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:HUANG, SHUANGFACILITY NUMBER:
434416456
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shuang HuangTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee, Shuang Huang for an unannounced required annual/post licensed inspection, and also in response to licensee change capacity request. LPA explained the nature of today’s inspection to Licensee. LPA observed an assistant (Licensee's daughter) and one infant and 5 children at home during the inspection. Days and hours of operation are Monday to Friday, 8:30am to 6:30pm. The adults that reside in the home is Licensee only. Licensee stated that her two renters (couple) has moved out on May, 9th, 2021, and she will not rent out any rooms going in the future. An update of the application was obtained on site.

Family Child Care Home Key Indicator Tool (KIT) #1 was used for the inspection.



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 also reminded Licensee 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. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, Licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s inspection. The entire home was inspected for health and safety hazards. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. LPA observed no stairs at home. The main area of the home is used for the day care are living room 1 & 2, bedroom 3 & 4, and bathroom #1. LPA observed two screened fireplaces. Off limit areas inside the home: kitchen, all bedroom 1 & 2, bathroom #2, and garage. Off Limit areas outdoor: right side portion of backyard, and two side yards behind the gated fence. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, at least one working smoke detector and on working carbon monoxide detector. Licensee states there are no weapons/firearms in the home. LPA obsrved a fenced backyard and no bodies of water. Licensee rent the house, and carries no child care liability insurance. Licensee purchase observed Affidavit Liability Insurance For Family Child Care Home under DCI.
Facility Evaluation Report dated 06/15/2021 to be continued on next page:
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HUANG, SHUANG
FACILITY NUMBER: 434416456
VISIT DATE: 06/15/2021
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Facility Evaluation Report dated 06/15/2021 to be continued from previous page:
LPA observed Licensee has current CPR and First Aid certification expiring 12/2021 as well as 8 hours of Preventive Health & Safety certification complete on 7/18/2020 including 1 hour of nutrition and lead poison prevention. LPA observed a current roster of the children. The last drills were conducted on 05/04/2021. LPA reviewed 6 children files mandated by the regulation including immunization records are maintained and up-to-date, and Notification of Parents’ Rights is in each child’s file.

Supervision of children was discussed with Licensee, and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. Licensee states that she does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time. LPA reviewed safe sleep policies for the infants with the Licensee and provided Licensee "A Child Care Provider's Guide to Safe Sleep” document as well as the most recent PIN 20-24-CCP for Infant SafeSleep and the requirement for checking and logging during the nap in every 15 minutes, including LIC 9227 for infants under one year old. More information can be founded at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing.

LPA discussed AB 2231: Civil Penalty Updates effective July 1, 2017 with Licensee. 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. A $100 per day for each violation for Failure to Correct, and $250 immediately and $100 per day per violation until corrected for Repeat Violations.

LPA discussed SB 792 Immunization Requirement with Licensee. LPA observed appropriate records for immunization against measles, pertussis, and influenza for Licensee and her assistant in file. Incidental Medical Services (IMS) were discussed with Licensee. Licensee is not providing IMS at this time. 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.htmLicensee will submit a plan of operation for IMS if in the future they provide any IMS to a child in care.

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. The training web site is available at: https://mandatedreporterca.com/ . Licensee has completed the training on 12/05/2019.
Facility Evaluation Report dated 06/15/2021 to be continued on next page:
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HUANG, SHUANG
FACILITY NUMBER: 434416456
VISIT DATE: 06/15/2021
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Facility Evaluation Report dated 06/15/2021 to be continued from previous page:

A fire clearance was granted for capacity of 14 (Large FCCH) from the Santa Clara Fire Department was received on 06/03/2021 and was on file.

No Deficiency was cited. Exit interview conducted with Licensee and advised her that a large Family Child Care Home license is now pending upon the management approval.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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