435700379-5-2-2023-52-CC-CURE-CRFLBR-20230502083710

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700379
Report Date: 05/01/2023
Date Signed: 05/02/2023 08:38:02 AM

Document Has Been Signed on 05/02/2023 08:38 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	FAN, SITING		FACILITY NUMBER:	435700379
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/01/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Siting "Gracie" Fan		TIME COMPLETED:	01:30 PM

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On 05/01/2023 at 10:00am, Licensing Program Analyst (LPA) Christina Uribe met with applicant Siting "Gracie" Fan for the purpose of conducting an announced pre-licensing inspection. No other individuals were present during today's inspection. LPA and applicant toured home for a health and safety inspection.

The facility is a single story home consisting of 2 bedrooms, 1 bathroom, living room, kitchen, attached garaged, and backyard which are neat and clean with heating and ventilation for safety and comfort. The off-limits areas will be made inaccessible by closed and/or locked doors and visual supervision.

On-Limit Areas: Bedroom #1, bathroom, kitchen, living room, garage, & backyard. Off-Limit Areas: Bedroom #2

The outdoor play area is located in the applicant’s backyard and is fully fenced and in good condition with no hazardous materials accessible to children in care. There are no pools, hot tubs, or any other bodies of water present in the on-limit areas. There is a fully enclosed chicken coop with three chickens at the far end of the backyard.

There are ample age-appropriate toys that are safe and in good condition. The home is equipped with a fully charged 3A40BC fire extinguisher, functional carbon monoxide detector, smoke detector, & telephone. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

The attached garage will be used by for an indoor play space when the weather restricts use of the backyard. Applicant is aware of their responsibility to ensure that children never eat or sleep in the garage. The garage has an additional smoke detector and carbon monoxide detector and does not have any hazardous materials accessible to children.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: FAN, SITING	FACILITY NUMBER: 435700379
	VISIT DATE: 05/01/2023

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Per applicant, there are no firearms in the home. The applicant is in compliance with the immunization laws which pertain to all childcare providers. Applicant completed and received certificates for Mandated Reporter Training & Pediatric CPR/First-Aid Training and was reminded of their responsibility to renew each training every two years.

Records to be Maintained: LPA reviewed the Packet of Records to be Maintained with applicant and thoroughly discussed each page and section for clarification and consultation. Applicant understands their responsibility for maintaining personnel and children's records, keeping complete and separate records for each child, and making them available for review upon request to the Licensing Department. LPA reviewed Personal Rights, Parents' Rights, Reporting Requirements, & Inspection Authority with the applicant. LPA reviewed with applicant the Forms/Records To Keep In Your Family Child Care Home (LIC 311D) form, children’s forms/records, facility forms/records, and information to be posted.

This facility plans on providing Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders, by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

Baby bouncers & drop-down cribs are not allowed at the daycare facility. Roster of children & their records must be properly maintained & available for review at all times. A fire/disaster drill must be performed and recorded every 6 months. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to the Community Care Licensing. The applicant was provided information regarding the effects of Lead Exposure and testing requirements (Assembly Bill 2370)

Page 2 of 3 ***Continued on LIC 809C***.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: FAN, SITING	FACILITY NUMBER: 435700379
	VISIT DATE: 05/01/2023

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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/per day up to $500.00 maximum/per day per person will be assessed if this regulation is violated

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

This home is recommended for Licensure on 05/01/2023. This report shall remain on file for 3 years. Exit interview was conducted with applicant, Siting "Gracie" Fan.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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