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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416485
Report Date: 12/28/2021
Date Signed: 12/28/2021 11:12:14 AM

Document Has Been Signed on 12/28/2021 11:12 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, GAO LANFACILITY NUMBER:
434416485
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 0DATE:
12/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:GaoLan LiTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Oscar Huang met with Licensee Gaolan Li 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 observed no daycare children in the home during today's inspection as the facility is closed for holiday (12/20 - 12/31). Days and hours of operation are Monday to Friday, 8:30 a.m. to 6:00 p.m. The adults that reside in the home are Licensee & a tenant only.

Licensee Gaolan Li 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.

Licensee agreed to give LPA a tour of the home both indoor/outdoor 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 Living Room, Dinning Room, Family Room, Main Bedroom, and Bathroom #1. LPA observed a blocked fireplace. Off limit areas inside the home: all other 3 Bedrooms (#2,3,& 4), Bathrooms 2 & 3, and Kitchen, there is no garage. LPA observed at least one functioning smoke and a carbon detector, fenced backyard, and no bodies of water. Off limits outdoor is the storage room. LPA advised licensee that whenever the climb structure is installed, softpad shall be placed on the ground around it to absorb falls. 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. Licensee 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. LPA observed 71 degree on the thermostat and advised her to keep temperature within 68-85 degrees. LPA observed a fully charged 3A40BC fire extinguisher, at least one working smoke detector and one functioning carbon monoxide detector.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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, GAO LAN
FACILITY NUMBER: 434416485
VISIT DATE: 12/28/2021
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Licensee rents the house, and carries child care liability insurance under DCI. LPA observed Licensee has current CPR and First Aid certifications expiring 11/2023. Licensee has completed her mandated reporter training on 5/9/2021 for child care providers and her certifications is 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 Gaolan Li 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 12/10/2021 and was on file: Fire Clearance granted: No violations found at inspection. A few recommendations were made, bedrooms #2, 3 & 4 and 1 bathroom are off limits. Main bedroom is now being used for infant (change from drawing).

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with licensee Gaolan Li, 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: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC809 (FAS) - (06/04)
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