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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701016
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:25:03 PM

Document Has Been Signed on 12/13/2023 12:25 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:LIEN, SHUANGFACILITY NUMBER:
015701016
ADMINISTRATOR:LIEN, SHUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 386-1921
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
12/13/2023
TYPE OF VISIT:Post LicensingANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Shuang LienTIME COMPLETED:
12:40 PM
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On 12/13/23 at 11:17am, Licensing Program Analyst (LPA) Briana Plumboy conducted an announced Prelicensing Site Inspection with Licensee Shuang Lien (Connie) for an ANNOUNCED RELOCATION INSPECTION. The licensee's previous license number was #015700316. Present for the inspection was 7 children in care and fingerprint clear and associated assistant Micaela Hughey. On 12/5/23, CCLD received an approved 850 which states, "Second Floor/ Story and garage are off limits." The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, from 8:30am until 5:30pm.

The home is 2 stories consisting of the following rooms on the second floor: master bedroom with master bathroom, 2 bedrooms and a hallway bathroom. The first floor consist of a living room, kitchen/dining room combo, half bathroom, laundry room, and garage. The home is neat and clean with heating and ventilation for safety and comfort. The licensee has requested the OFF LIMIT AREAS BE: the entire second story of the home and garage which will be inaccessible by a barrier gate at the bottom of the staircase, and closed and/or locked doors and visual supervision. The applicant has requested the following rooms be ON LIMITS the living room, kitchen/dining room combo, laundry room, bathroom, and backyard. The ISOLATION AREA will be an area in the living room. The BACKYARD play area is completely fenced and there are no play structures present during today's inspection which are required to be anchored. There are toys and learning materials present at the facility during today's inspection. Licensee is aware if toys are broken or not in the manufactures intended form, they must be restored to the manufactures intent, replaced, or removed from the childcare areas of the home. Licensee is aware at all times all equipment must be used following manufacture guidelines and Title 22 Regulations. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection.
See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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: LIEN, SHUANG
FACILITY NUMBER: 015701016
VISIT DATE: 12/13/2023
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The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 11/4/25. The licensee's mandated reporter training is complete and she received a certificate of completion on 10/5/23, and assistant Micaela Hughey received her certificate on 9/26/22. The licensee and Micaela are in compliance with the immunization law which pertains to day care providers. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home. A copy of the mortgage statement was reviewed and shows control of property.

Licensee is aware it is her responsibility to have knowledge of all Title 22 Regulations prior to accepting children into care at her facility.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing 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, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

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

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



Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LIEN, SHUANG
FACILITY NUMBER: 015701016
VISIT DATE: 12/13/2023
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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

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, the licensee Shuang Lien confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Entrance Checklist was provided to the licensee.

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-andresources/safe-sleep, as an additional resource. LPA also informed 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

This home is recommended for licensing on 12/13/23. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. This report shall remain on file for 3 years. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
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