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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701016
Report Date: 09/17/2024
Date Signed: 09/17/2024 03:08:53 PM

Document Has Been Signed on 09/17/2024 03:08 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/
DIRECTOR:		LIEN, SHUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 386-1921
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Licensee, Lien ShuangTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini arrived at the facility unannounced for a ten-day visit and observed three infants sleeping in the second level of the house. According to the fire clearance issued by Dublin Fire Prevention on December 5, 2023, the second story is explicitly marked as off-limits. Additionally, the licensee was reminded during the pre-licensing inspection that the second story is designated as off-limits. The licensee acknowledged understanding that the second floor is designated as off-limits. However, she chose to use the area to provide additional space for sleeping.

Also, during the inspection, the Licensing Program Analyst (LPA) observed that the licensee and a helper were supervising seven children—five infants and two preschoolers—which resulted in the facility being over capacity.

See 809-D for two TYPE A deficiencies cited on today's visit.

THE LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAY'S VISIT WITH THE NOTICE, AND THE LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR THE AB 633 FACT SHEET AND A COPY OF THE ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

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

The Facility's appeal rights were reviewed and given to the licensee, Lien Shuang.

An exit interview was conducted with Licensee, Lien Shuang.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/17/2024 03:08 PM - It Cannot Be Edited


Created By: Jyoti Saini On 09/17/2024 at 02:21 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: LIEN, SHUANG
FACILITY NUMBER: 015701016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2024
Section Cited
CCR
102416.3(a)(6)

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102416.3 Alterations to Existing Buildings or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds,.... , but not limited to, the following: (6)Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.This requirement is not met as evidenced by:
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The licensee shall move the infant into a crib in the "on-limit area." The Licensee shall also submit a statement that identifies the facility's 'on' and 'off' limits areas and how she will ensure that children are not in the 'off limits' areas to the department by the POC date.
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above. LPA observed three infants sleeping in the second level of the house marked as off-limits, which poses an immediate risk to the health, safety, and personal rights of the children in care.
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Type A
09/18/2024
Section Cited
CCR102416.5(a)

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102416.5 Staffing Ratio and Capacity
a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time

This requirement is not met as evidenced by:
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Licensee shall submit a plan of correction to demonstrate how she is going to maintain the day care within ratio and capacity by 09/18/2024. LPA discussed ratio requirements for a large Family Child Care Home with Licensee.
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above as the Licensee and helper were supervising five infants and two preschoolers, which poses an immediate risk to the health, safety, and personal rights of the children in care.
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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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024


LIC809 (FAS) - (06/04)
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