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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700079
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:47:33 PM

Document Has Been Signed on 12/10/2021 02:47 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LIU, YANFACILITY NUMBER:
015700079
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Yan LiuTIME COMPLETED:
03:05 PM
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On 12/10/2021, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of a Required 1-Year Inspection. LPA was met by Licensee, Yan Liu, and Licensee's fingerprint cleared and associated husband, Kwon Chiu. Present for this inspection are the Licensee, the Licensee's husband, and five napping children in care (preschool-aged). Facility operating hours are 8:30-6:30pm M-F. The facility was toured to conduct a health and safety inspection.

The home is a 1-story home. On-limit-areas: Two "living rooms for daycare", first bathroom on the right side of the hallway, fenced-off area of the backyard, patio enclosure. Off-limit areas: all bedrooms, dining room, kitchen, garage, area of the backyard beyond fence enclosure. All off-limit areas are made inaccessible to children via locked and/or closed doors and visual supervision. Isolation room: living room behind curtains for sleeping.

At 12:55am, LPA toured the facility interior. The home is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the home. Fireplace is barricaded. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children. There are no firearms kept in the home at this time, per Licensee. Nobody smokes in the facility, per Licensee.



At 01:24pm, LPA toured the backyard. All play equipment was observed to be operable and age-appropriate during this inspection. Cushioning material is present in the backyard to absorb falls (lawn). The backyard is fenced. There are no pools, hot tubs, ponds or any other bodies of water located in the on-limit areas of the facility premises at this time.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIU, YAN
FACILITY NUMBER: 015700079
VISIT DATE: 12/10/2021
NARRATIVE
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The facility has a fully charged 2A10BC fire extinguisher and working telephone. Smoke/carbon monoxide detectors are fully functional, per Licensee. Mandated Reporter training for Licensee is current. CPR/1st Aid certificate for Licensee is current. The facility is in ratio today. The facility conducts fire/disaster drills at least once every 6 months. All required forms are posted in public view.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. The following information regarding ADA (Americans with Disabilities Act) 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.”

Licensee 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.

Licensee was reminded that California Law requires licensed Family Child Care Homes 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). Incidents must be reported within 24 hours by phone, fax, or electronic mail and the LIC624b must be submitted within 7 days. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email [email protected] to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee 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 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIU, YAN
FACILITY NUMBER: 015700079
VISIT DATE: 12/10/2021
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No deficiencies were cited today. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Licensee and the signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee.

This report was reviewed with the assistance of a Language Link translator, as LPA and Licensee do not speak the same language. Mandarin Chinese is the language Licensee is most comfortable speaking.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
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