435700400-7-5-2024-52-CC-JZHU-D6VRBJ-20240705125248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700400
Report Date: 07/05/2024
Date Signed: 07/05/2024 12:53:00 PM

Document Has Been Signed on 07/05/2024 12:53 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HSU, SHUHUAN		FACILITY NUMBER:	435700400
ADMINISTRATOR/ DIRECTOR:	SHUHUAN HSU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 494-7389
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	07/05/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Shuhuan Hsu		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE

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On 07/05/2024 at 9:15am, Licensing Program Analyst (LPA) Jialing Zhu, met with applicant Shuhuan Hsu for an ANNOUNCED PRELICENSING INSPECTION. Present during the inspection were applicant, applicant’s fingerprint-cleared daughter, fingerprint-cleared staff, and applicant’s two (2) minor grandchildren. The applicant lives by herself in the home. An Entrance Checklist was provided to the applicant. The home was toured to conduct a Health and Safety Inspection. The facility’s intended hours of operation are Monday-Friday from 8:30am to 6:00pm. Intended ages of children to be served at this facility is 2-6 years old. LPA conducted parts of the prelicensing in Mandarin. Applicant’s daughter also assisted during the prelicensing with translations.

The home is a one-story home with three (3) bedrooms, two (2) bathrooms, living room, kitchen, sunroom, covered deck, attached garage, front yard, and backyard.

The ON-LIMIT AREAS are Bedroom 1 (for napping), Bathrooms 1 and 2, living room, kitchen, sunroom (classroom), front yard, and backyard.

The OFF-LIMIT AREAS are garage, Bedroom 2, and Bedroom 3, and covered deck (next to sunroom), which will be inaccessible by closed and/or locked doors and visual supervision. The garage will be used as a walkthrough only to enter the inside of the home with 100% visual supervision.

The ISOLATION AREAs are the living room and kitchen. When a child shows signs of illness, he/she will be separated from other children here.

The inside of the home is observed to be clean and orderly, with central heating and ventilation for safety and comfort. LPA observed there are ample safe and age-appropriate toys, play equipment and materials. All toxins, cleaning products, and hazardous materials have been made inaccessible to the children. There are no firearms and no pets in the home. The home does not have a fireplace.

Page 1 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSU, SHUHUAN	FACILITY NUMBER: 435700400
	VISIT DATE: 07/05/2024

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There is a fully charged 3A40BC fire extinguisher in the sunroom. There are two (2) working combination smoke and carbon monoxide detectors, located in the living room and sunroom. There is telephone service in the home.

Per licensee, there are no cribs or play yards in the home because the facility does not provide care to infants. Sleeping mats will be provided to the children in care, but children will be bringing their own bedding. Applicant stated that she will provide AM/PM snacks and lunch. LPA informed applicant that all beddings and food brought from children’s home shall be labeled with the children’s name and stored appropriately. The applicant will not provide transportation to children.

The outdoor play area is the front yard and backyard, which is completely fenced with visual supervision. Applicant states the front yard is the primary outdoor area, where they have recess and lunch. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of age-appropriate toys and activities available for children, and they are in good condition. There is ample shade available in the front yard, and gates are locked at all times while children are in the yards.

There is a play structure equipped with a slide and a small climbing structure in the back yard. The ground around the structure is made of turf. Applicant was reminded to keep in mind the manufacturer's age range on the play structure. The play structure equipped with a slide is properly secured to the ground.

There are two (2) large sheds in the backyard used as storage for home and gardening supplies. Applicant understands the sheds must be locked at all time. LPA did not observe any bodies of water on premises during today’s inspection.

Applicant was reminded that any changes to the on/off-limit areas, inside of the home, and outdoor area, including construction of additional play structures, must be reported to and approved by licensing before it can be used.

The applicant completed the Health and Safety training. The applicant’s Pediatric CPR/First Aid certification are current and expire on 06/08/2026. The applicant has completed the Mandated Reporter training for Child Care Providers (AB1207) and expires on 06/07/2026. The applicant is in compliance with the immunization laws.

Page 2 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSU, SHUHUAN	FACILITY NUMBER: 435700400
	VISIT DATE: 07/05/2024

NARRATIVE

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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Applicant understands the family child care home must have a current roster of children who are provided care in the facility, and this roster shall be available to the licensing agency upon request. Applicant also understands that fire/disaster drills must be conducted every six (6) months and documented. Applicant has liability insurance for the facility. Applicant will provide details to LPA via email.

Applicant was reminded that California Law requires 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 624B). Any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov.

Applicant was also reminded that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Applicant was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant is the owner of the property so landlord notification and/or consent is not required.

Page 3 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HSU, SHUHUAN	FACILITY NUMBER: 435700400
	VISIT DATE: 07/05/2024

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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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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.htm.

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 information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

License has been approved for applicant today, 07/05/2024. Exit interview was conducted and report was reviewed with the applicant, Shuhuan Hsu. Page 4 of 4. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

LIC809 (FAS) - (06/04)

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