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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700366
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:39:01 PM

Document Has Been Signed on 08/31/2023 04:39 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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LIU, LING CHUFACILITY NUMBER:
015700366
ADMINISTRATOR:LIU, LING CHUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 398-7038
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Ling Chu LiuTIME COMPLETED:
04:45 PM
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On August 31, 2023 at approximately 1:15pm Licensing Program Analyst (LPA) Russ Haderer met with licensee Ling Chu Liu for the purpose of conducting an unannounced annual inspection for health and safety. Living in the home is the licensee, her TB test and fingerprint cleared two adult sons and adult daughter. Present in the home at the time of inspection was the licensee and her three adult children and three children in care (all infants). The hours of operation remain Monday-Friday, 9:00am to 6:00pm.

The facility is a two-story home with 5 bedrooms and 3 bathrooms; a family room (with a fully screened fireplace); living room; utility room (converted to childcare room); kitchen; dining room; laundry room, attached 2-car garage; side and backyard patio areas. There is a child gate at the bottom of the stairs preventing children from accessing the upstairs areas. The backyard contains 2 sheds, a covered and locked jacuzzi and a large patio area. There is a six-foot wood fence surrounding the backyard with gates for emergency egress.



Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in utility room daycare area away from the other children in care.

On-limit-areas include: Living room (day care area); family room; dining room; utility room (day care area on left side of the kitchen); the first floor bedroom on the right side of the living room; first floor full bathroom; outside main patio area off the family room on the east side of the of the home.

Off-limit-areas include: The entire upstairs; kitchen (there is a child gate installed to prevent children from access); the attached 2-car garage; outside side yards (north and south patio areas); both sheds and a swing set (2 swings) on western side of back yard. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIU, LING CHU
FACILITY NUMBER: 015700366
VISIT DATE: 08/31/2023
NARRATIVE
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There were ample age appropriate toys that were observed to be safe and in good condition. The home and the day care area and rooms are neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

There are two fully charged 3A40BC fire extinguishers, one is wall mounted by the front door and the second one wall mounted near the kitchen. There is an additional 2A10BC located in the garage. The facility has multiple working (tested and functioning) smoke and carbon monoxide detectors. Fire and disaster drills are required to be conducted at least once every six months, the last drill was completed March 21, 2022; well past the required interval – see LIC809D for deficiency. Per licensee, there are no firearms in the home.

Children’s files were reviewed, a copy of the roster was taken for the office file. One child’s file was missing the LIC9227 Infant Safe Sleep plan (child is now over 12 months – a technical violation was issued), one child’s file was missing a signature on the LIC627 Consent for Emergency Medical Treatment – see LIC809D for deficiency, one child’s file was missing the signature on the LIC995 Parents Rights form – see LIC809D for deficiency.

The licensees Pediatric CPR/First Aid certificate is current and expires 3-25-2025. Mandated reporter training was completed on 9/05/2022, assistants certificates expired on 8/07/2023 – a technical advisory was issued. Licensee’s primary helper (son Christopher) CPR/1st Aid expires 9/04/2023. Licensee and helpers are in compliance with all immunization laws required for child care providers. LPA reminded the licensee of the following: Mandated Reporter certificate and CPR/First Aid certificate must be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.
The licensee rents the property and carries childcare liability insurance through Charter Risk Management, underwritten by Mesa Underwriters Insurance Co. policy expires 6/02/2024. LIC9151 Property Owner Notification form completed and signed.
Licensee was reminded that all adults 18 and over living or working in the home, 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.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIU, LING CHU
FACILITY NUMBER: 015700366
VISIT DATE: 08/31/2023
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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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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 informed of the MyChildCarePlan.org website; 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.

During the exit interview, licensee Ling Chu Liu confirmed there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

The following deficiencies were observed during today's inspection:


- Disaster drills were not conducted at least once every six months
- Parent’s signature missing on LIC627 Consent for Emergency Medical Treatment
- Parent’s signature missing on LIC995A Parent’s Rights
See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
**Please see LIC 9102 for Advisory Notes.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Ling Chu Liu.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 08/31/2023 04:39 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/31/2023 at 04:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LIU, LING CHU
FACILITY NUMBER: 015700366

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that last disaster drill was completed March 21, 2022, well past requirement of once every six months which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2023
Plan of Correction
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Licensee to conduct a fire or earthquake disaster drill and ensure they are done at least once every six months. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that a parent's signature missing on one of the children's form LIC995 Parent's Rights which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2023
Plan of Correction
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Licensee to collect parents signature on the form and ensure that going forward parents sign and date these LIC995A forms. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 08/31/2023 04:39 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/31/2023 at 04:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LIU, LING CHU
FACILITY NUMBER: 015700366

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that parent's signature missing on one of the children's LIC627 Consent for Emergency Medical Treatment form which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2023
Plan of Correction
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Licensee to collect parents signature on the form and ensure that going forward parents sign and date these LIC627 forms. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
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