455407985-10-28-2021-13-CC-JSNW-C8953B-20211028193536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455407985
Report Date: 10/28/2021
Date Signed: 10/28/2021 07:36:32 PM

Document Has Been Signed on 10/28/2021 07:36 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	YANG, FE FAMILY CHILD CARE HOME		FACILITY NUMBER:	455407985
ADMINISTRATOR:	YANG, FE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 881-6590
CITY:	PALO CEDRO	STATE: CA	ZIP CODE:	96073
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/28/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	'Mindy' Fe Yang		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A change of location inspection was conducted today by Licensing Program Analyst (LPA) Snow. This inspection was conducted via Facetime due to the COVID-19 Pandemic. The licensee is requesting a license for a capacity of up to 14. Services will be provided Mon-Fri 7am - 6pm. The residence is a three bedroom/ two bath home. There are three adult currently living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Two of the bedrooms are off limits and key locked. The kitchen is off-limits by use of a child gate. Household cleaners are inaccessible. Poisons are key locked in the detached garage. The sharp knives and medications are stored out of the reach of children. There are no firearms stored in the home; the LPA did not observe any weapons during the visit. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector and carbon monoxide detector. A fire extinguisher rated at least 2A10BC was observed. Access to the fireplace is blocked and attached to the wall. The children will use the backyard as the outdoor play area and it is fully fenced. The swing is anchored into the ground. There is a pool with fencing on three sides; a waiver will be required. The fence is 5ft high cyclone with 2.5” gaps on 2 sides and a 5 ft wooden fence on the third side with the neighbor. No openings or gaps over 4”. The gate is not self closing or self latching during the visit today.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: YANG, FE FAMILY CHILD CARE HOME	FACILITY NUMBER: 455407985
	VISIT DATE: 10/28/2021

NARRATIVE

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The applicant may intend to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.htm.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Parent's rights poster is posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days.

The licensee will maintain current on Pediatric CPR and First. The licensee shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The licensee understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The licensee clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in those areas where childcare is provided.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: YANG, FE FAMILY CHILD CARE HOME	FACILITY NUMBER: 455407985
	VISIT DATE: 10/28/2021

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The licensee understood the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website (http://ccld.ca.gov/). Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understood that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the applicant. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

No citations were issued during today's visit.

The home is ready for licensure with the exception of the pool fencing as follows:

1) The applicant will install a latch that is self-close and are self-latching. 102417(g)(5)(A). The self-latching device should be located no more than six inches from the top of the gate. 102417(g)(5)(A). Send photos when complete.

2) Applicant will request a waiver because the fence surrounds 3 sides of the pool and the third side is blocked by the home; there is one door that leads directly into the pool area. (102417(g)(5))

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC809 (FAS) - (06/04)

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