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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701186
Report Date: 10/21/2024
Date Signed: 10/21/2024 07:40:14 PM

Document Has Been Signed on 10/21/2024 07:40 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:
015701186
ADMINISTRATOR/
DIRECTOR:		SHUANG LIENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 386-1921
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 0DATE:
10/21/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
06:40 PM
MET WITH:Shuang Lien- ApplicantTIME VISIT/
INSPECTION COMPLETED:
07:50 PM
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On 10/21/24, Licensing Program Analyst Briana Plumboy, met with applicant Shuang Lien (Connie) for an ANNOUNCED PRE LICENSING INSPECTION. The home was toured to conduct a Health and Safety Inspection. The applicant received an approved fire clearance on 10/10/24 by Dublin Fire Prevention Services with no restrictions. The applicant plans to operate the facility Monday through Friday from 8:00am until 5:30pm.

The home is single story. The home consists of 2 bedrooms, a master bedroom with master bathroom, hallway bathroom, combined dining room/ kitchen, living room, and garage. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the bedroom located at the end of the hallway all the way to the right, hallway bathroom, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the first bedroom located left side of the hallway, master bedroom with master bathroom (second room), combined dining room/ kitchen, living room, and backyard. The ISOLATION AREA will be the master bedroom for preschool age children, and the first bedroom on the left if the child is an infant. Outdoor play area will be in the fenced backyard. The children in care will not play on the left or right sides of the home, or on the pathway. The children in care will utilize the play area off the kitchen. There are toys, learning materials, and play equipment. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items which could be accessible to children during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, pull down fire alarm, working telephone, and first aid kit. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 11/4/25. The applicant completed and received a certificate in mandated reporter training on 10/5/23. The applicant is in compliance with new immunization law which pertains to day care providers. The fireplace is screened to prevent access by children and located in the dining room. Per applicant, there are no firearms in the home. A copy of the lease was reviewed and shows control of property.
See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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: 015701186
VISIT DATE: 10/21/2024
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LPA discussed the safe sleep regulations with applicant Shuang Lien 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 applicant 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 the 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.

The applicant Shuang Lien was reminded nothing shall hang over the infant cribs and not to swaddle infants while in care.

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



Applicant 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. Applicant is reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov
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.

See 809-C for continuance

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

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
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: 015701186
VISIT DATE: 10/21/2024
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Applicant Shuang Lien is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Entrance Checklist was provided to the applicant.



Because the applicant Shuang Lien rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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

This home is recommended for licensing on 10/21/24. The applicant is aware the signature on this report confirm receipt of these documents. LPA asked the applicant if the applicant had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the applicant, and per applicant, there are no further questions at this time. Applicant is aware at anytime she can reach out to LPAs Saini or Plumboy or CCLD. Appeal rights provided and discussed. This report shall remain on file for 3 years. Exit interview conducted with applicant Shuang Lien.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
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