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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416482
Report Date: 12/15/2021
Date Signed: 12/15/2021 02:37:15 PM

Document Has Been Signed on 12/15/2021 02:37 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LIU, QIANYIFACILITY NUMBER:
434416482
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
12/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Qiany LiuTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee Qianyi Liu for an unannounced case management inspection due to licensee's capacity increase request & Post-Licensing visit. LPA explained the nature of today’s inspection to Licensee. LPA also observed 5 daycare children (3 infants & 2 preschoolers) in the home during today's inspection. Days and hours of operation are Monday to Friday, 8:00 a.m. to 6:00 p.m. The adults that reside in the home are Licensee & her husband only.

Licensee Qiany Liu 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. 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 toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home appears clean and orderly, with heating and ventilation for safety and comfort of the children. Licensee observed the temperature was 72 degree displayed on the thermometer, LPA advised her to keep temperature within 68-85 degrees. LPA observed no baby walker, bouncers, excer-saucers, jumpers etc. on the premises. LPA observed no stairs inside the home. The main area of the home is used for the day care are Bedroom #2 (napping), Living Room & Family room, and Bathroom #2. LPA observed a screened fireplace. Off limit areas inside the home: Bedrooms #1(master), & 3, Kitchen, laundry and Garage. LPA observed at least one functioning smoke and carbon detector, fenced backyard, and no bodies of water. Off limits outdoor are areas marked as flower garden areas and two sides. 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 in top cabinets in the kitchen inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, at least one working smoke/detector and one carbon monoxide detector. Licensee states there are no weapons/firearms and pets in the home.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LIU, QIANYI
FACILITY NUMBER: 434416482
VISIT DATE: 12/15/2021
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Licensee rents the house, and carries child care liability insurance under ACORD. LPA observed Licensee has current CPR and First Aid certifications expiring 5/2023. Licensee has completed her mandated reporter training on 6/2/2021 for both the general & child care providers and her certifications are on file. LPA observed a current roster of the children. LPA reviewed all children files mandated by the regulation.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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. LPA observed Infant Sleeping Plan and 15 minutes check logs.

Incidental 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: https://www.ada.gov/childqanda.htm



A fire clearance granted from the Sunnyvale Fire Department was received on 12/07/2021 and was on file: Fire Clearance granted on 12/07/2021: Inspection conducted on 10/11/21. Reinspection & Fire Clearance granted on 12/7/21. Exit Sign, smoke detector and pull stations all installed. No daycare use permitted in Bedroom #1, Bedroom #3, Kitchen and Garage.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with licensee Qianyi Liu, and advised her that a Large Family Child Care Home license is now pending upon management approval.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
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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