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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700316
Report Date: 02/01/2023
Date Signed: 02/01/2023 02:24:31 PM

Document Has Been Signed on 02/01/2023 02:24 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:LIEN, SHUANGFACILITY NUMBER:
015700316
ADMINISTRATOR:LIEN, SHUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 386-1921
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Licensee, Shuang LienTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Lien Shuang for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee, and helper supervising 3 infants and 5 preschoolers. 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 and backyard. The hours of operation are 8:30AM- 5:30PM, Monday -Friday.

ON-LIMIT AREAS are the master bedroom (nap room) and attached bathroom, bedroom #3, the kitchen with dining area, living room (main day care area) and backyard.

OFF-LIMIT AREAS are the garage, bedroom #2 and hallway bathroom and made inaccessible to children by locked doors, safety gates and visual supervision.

LPA inspected the house for health and safety hazards. Daycare Area is clean, orderly, and equipped with age appropriate toys and equipment for children, indoors and outdoors. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water in the day care. There is a fireplace in the dinning area which is not in use. There are child size tables and chairs for snack and activities. There are ample of age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The napping room had cots in good condition. Licensee states there are no guns or weapons of any kind in the home. The outdoor play area is fenced.


Licensee and helper have valid CPR. Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children’s files. All the files are complete and up to date. All required postings are properly posted. LPA reviewed and obtained a copy of the roster. The last fire drill was conducted on 11/21/2022.

see next page

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIEN, SHUANG
FACILITY NUMBER: 015700316
VISIT DATE: 02/01/2023
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During Inspection, 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.

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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with the licensee Shuang Lien.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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