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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700316
Report Date: 02/03/2022
Date Signed: 02/03/2022 11:11:21 AM

Document Has Been Signed on 02/03/2022 11:11 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LIEN, SHUANGFACILITY NUMBER:
015700316
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shuang LienTIME COMPLETED:
11:30 AM
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On 2/03/2022 at 9:15am Licensing Program Analyst (LPA) Jaylena Miller met with applicant Shuang Lien for an announced Pre-Licensing Inspection. The applicant has applied for an initial Family Child Care Home License. The applicant plans to operate Monday-Friday from 8am-6pm for ages 2 years and older. LPA conducted a health and safety inspection inside and outside with applicant.

The home is a single-story home with 3 bedrooms including a master bedroom with bathroom, one bathroom located in the hallway, a living room, a kitchen with dining area, garage that is accessible through a door in the kitchen and backyard which is completely fenced in. The home is neat and clean with central heating and ventilation for safety and comfort however during the inspection LPA observed the home to be very cold and let applicant know the temperature in the home needs to be comfortable for children. There is a shed in the backyard that will be inaccessible by pad lock. There is a fireplace located in the kitchen dinning room that is screened to prevent access to children.

The OFF-LIMIT AREAS are the garage and the third bedroom adjacent to the hall bathroom and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the master bedroom and bathroom and will be used as a nap room for children, the first bedroom across from the master bedroom that will also be used for daycare children as an additional playroom/nap room, the hallway bathroom will be the main bathroom used by daycare children, the kitchen with dining area, living room which is the main daycare area. The designated isolation area will be the first bedroom. The outdoor play area will be the backyard.

All hazardous materials and toxins are kept out of reach from children and would not be accessible to children during care. The home has a fully charged 2A-10-BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and first aid kit. Per applicant, there are no firearms on the premises. The kitchen cabinets and drawers have child safety latches and knives and sharp objects are kept out of reach of children.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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: LIEN, SHUANG
FACILITY NUMBER: 015700316
VISIT DATE: 02/03/2022
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The applicant has received certificates of completion in Preventative Health and Safety training on 10/17/2021, the mandated reporter training on 10/19/2021, and CPR and First Aid which is current and expires on 11/12/2023. LPA Miller discussed with applicant the CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. The applicant has proof of the provider immunizations on file.

LPA also discussed with applicant that ALL assistants, Volunteers, frequent visitors, or adults living in the home, over the age of 18, must be fingerprint cleared and associated to the home prior to being in the presence of children in care. An immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded.

LPAsprovided a copy of Safe Sleep Regulation Concept, and Safe Sleep in Child Care brochure, and a handout "What Does A Safe Sleep Environment Look Like?" to the applicant.

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to CCL. Also, any adults moving into the home must be reported to CCL prior to them moving in and all requirements must be met before the person lives in the facility.

California Law requires Family Child Care Home 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 by phone to CCL Desk Duty Analyst and LIC 624 within 7 business days.

A Roster of the children must be properly maintained, and fire/disaster drill once every six months must be documented.

The applicant was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

For licensing updates please email [email protected] and ask to be added to the email list.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: LIEN, SHUANG
FACILITY NUMBER: 015700316
VISIT DATE: 02/03/2022
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Individual Medical Services (IMS) policy was discussed. The applicant is reminded that when any changes to the IMS plan is made, an updated 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 website at: http://www.ada.gov/childganda.htm.

The following corrections are required before the home can be licensed:


· Applicant must be completely moved in and living in the home
· Applicant must have food in refrigerator and cabinets
· More toys for outside play (LPA observed 1 bike, 1 soccer ball, 1 toy truck and a tent)

These corrections can be submitted by providing pictures within two weeks of the date of this report. LPA may visit facility to confirm corrections have been complete. This report shall remain on file for 3 years.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
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