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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314208
Report Date: 08/09/2023
Date Signed: 08/09/2023 02:50:00 PM

Document Has Been Signed on 08/09/2023 02:50 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:TANG, ANQIFACILITY NUMBER:
304314208
ADMINISTRATOR:TANG, ANQIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(917) 306-5961
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
08/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Tang AnqiTIME COMPLETED:
03:05 PM
NARRATIVE
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On 8/9/2023, Licensing Program Analyst (LPM) Magana, (LPA) Trinh, and (LPA) Navar conducted an announced, in-person Pre-Licensing inspection for a new Large Family Child Care home. The LPAs met with applicant Tang Anqi, who provided a tour of the home. A review of the Facility Personnel Report Summary indicates 2 adults live in the home that is included licensee. The adult residents received caregiver background check clearances or exemptions as required by the Department. Per the applicant, there are two minors living in the home.

The applicant stated that she is not registered with any Resource Foster Care agency and that she does not hold a Resource foster parent license. The applicant was reminded to notify the licensing office of any changes.

The applicant is requesting a large Family Childcare Home license. Per the applicant, operation hours will be Monday through Sunday, 8:30 AM- 6:00 PM. Care and supervision will be provided to children ages newborn to 2 years old through 6 years old. For the purposes of licensing, an infant is defined as any child 0 to 24 months of age.

All areas on the Facility Sketch LIC999 were inspected, including but not limited to, off-limits areas. The facility is a 2-story home with 2 bedrooms, 2 bathrooms, a living room, a kitchen, a laundry room, a front yard (not fenced), a backyard (fenced), and a garage. There is a fireplace, located in the living room, with screen proctor. Applicant stated that they do not turn it on. There are stairs barricaded by a child-proof safety gate.

Cont page 2
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: TANG, ANQI
FACILITY NUMBER: 304314208
VISIT DATE: 08/09/2023
NARRATIVE
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Based on the Facility Sketch LIC999 submitted, the living room has been assigned as the primary daycare space, while the room behind the living area serves as both a nap room and a study room for the children in daycare. Upon entering the facility, the children's bathroom is in the front right hand side area. Across the hallway next to the designated piano classroom, is positioned next to the laundry room. The applicant has clarified that the closet situated between the laundry room and the closet to the stairwell will be used exclusively for personal belongings, and children toys.

The applicant has designated the entire 2nd floor of limit, and has a child-proof safety gate at the bottom of the stairs to the 2nd floor, ensuring the 2nd floor is inaccessible to children in care. The applicant has placed child-proof safety gates in the living room destinated as a reading area. The pantry in the kitchen is key lock. The applicant has a lock on the garage door that is located in the hallway ensuring this area is inaccessible to the children in care.


The applicant understands that licensing staff may have access to off-limits areas during inspection visits if necessary.

Areas Designated for Day Care Activities: The applicant has designated the living room, one bathroom at a music room, and back yard as the daycare areas.

Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation, and heating. The children’s bathroom was observed to be safe and free of hazardous items. The applicant has a small step tool in the children’s bathroom. The designated childcare areas were observed to have age-appropriate toys and educational items.

Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant stated that there are no poisons on the premises and LPAs did not observe any. The applicant was advised that any poisons must be locked with a key or combination lock. The applicant stated that there are no weapons or firearms on the premises. The LPAs informed the applicant that when firearms are present, they must be locked and stored separately from the ammunition per CCR 102417(g)(4)(C).
cont page 3
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: TANG, ANQI
FACILITY NUMBER: 304314208
VISIT DATE: 08/09/2023
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The pressure gauge on the 2A-10BC fire extinguisher(s) indicates fully charged, as indicated on the service tag observed. Smoke and carbon monoxide detectors were tested and are operable. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Or there are no pets (animals) in this facility.

OUTDOOR PLAY AREA: Outdoor play activities will be conducted in the backyard. The backyard is appropriately walled. LPAs observed age-appropriate play equipment to be free from hazards. There are no bodies of water on the premises.

The applicant stated she will provide food for the children. The applicant was informed that if children bring food from home, the children’s names must be labeled on their lunch bags and refrigerated/stored properly. The applicant stated mention she will do the survey to see which children has a allergy.

Per the applicant, children will nap in 164 Pavilion Park Irvine Ca 92618. Children will nap on cots and infants in cribs/play yards. The licensee understands that there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

The applicant stated that parents will provide linens and blankets for napping. The applicant stated that parents will provide diapers, lotion, wipes, and formula for the infants. Per the applicant, a changing table/ floor I will be used to change diapers. LPAs advised the applicant to always supervise infants visually when changing their diapers.

A records review indicates the applicant completed the required Health and Safety Training with Nutrition and Lead Poisoning components. The applicant has a current Pediatric First Aid and CPR certification that expires on 5/19/2025. A first aid kit is available at the facility.

Per the applicant, there are no dual licenses at this address. The applicant’s email address was obtained during this inspection. The applicant was advised that the email address may be public information.

cont page 4
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: TANG, ANQI
FACILITY NUMBER: 304314208
VISIT DATE: 08/09/2023
NARRATIVE
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The applicant will receive children at the front door. Per the applicant, upon arrival children’s temperature will be taken, their hands will be sanitized, and the children will be taken to the designated daycare area by the applicant. COVID-19 guidelines and precautions were discussed with the applicant.

In the absence of the licensee, a qualified adult must be present to supervise the children—a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance and immunization, and valid criminal record clearance that is associated with the licensed facility.

Annual fees must be paid by the due date, or a late fee shall be assessed and/or the License may be terminated.

The Child Advocacy Program was discussed with the applicant. The applicant was advised to register for the program to receive quarterly reports and other information in a timely manner. To register email [email protected].

Reporting Requirements:

1. Changes should be reported to the Department as soon as they occur, such as construction, remodeling, telephone number changes, and/or moving out from your home.

2. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Each family child care home must conduct fire drills and disaster drills at least once every six months. The licensee must document the date and time of each drill. This documentation must be kept at the facility for review by the Department.



No smoking, No Johnny jumpers, No saucer chairs: any other items that fall into that category are prohibited in the facility.


cont page 5
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: TANG, ANQI
FACILITY NUMBER: 304314208
VISIT DATE: 08/09/2023
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STAFF FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records as specified in Title 22 Regulations 102416.1, Notice of Employee Rights (LIC 9052), one Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108) per provider, Copy of Pediatric Cardiopulmonary Resuscitation & Pediatric First Aid (CPR & First Aid Certification), Proof of pertussis, measles, and Tuberculosis (TB) vaccines, Proof of influenza vaccine (or documentation of exemption), Proof of Mandated Reporter Training certificate, Copy of Criminal Background Clearance Transfer Request (LIC 9182), Copy of Criminal Record Exemption Transfer Request (LCI 9188).

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by law to post the following:
Facility License (LIC 203), Waivers (if applicable), Notification of Parent’s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). ). A Notice of Site Visit (LIC 9213) must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)
Capacity Handouts for a Small Family Child Care Home and Large Family Child Care Home were provided.

The following was discussed with the applicant:
The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to initial presence in a licensed facility. Violation of this requirement will result in a citation and civil penalties of one hundred dollars ($100) per violation, per day for a maximum of five (5) days for a first offense. Subsequent violations will result in civil penalties for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.
cont page 7
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: TANG, ANQI
FACILITY NUMBER: 304314208
VISIT DATE: 08/09/2023
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Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection authority, which includes but is not limited to the right to enter the house when children are being cared for, interview children and adults, and review documentation.

The LPA advised the applicant(s) on how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov/inforesources/community-care-licensing. LPA reviewed and issued the LIC311D “Forms/Records to Keep in Your Family Child Care Home” and provided the forms below.

CHILDREN FORMS/RECORDS - Children’s files must contain the following completed documents and information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Affidavit Regarding Liability Insurance (LIC 282), Parent Notification Additional Children in Care (LIC 9150), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), California School Immunization Record (CDPH 286), Individual Infant Sleeping Plan (LIC 9227), Risk and Effects of Lead Poisoning (PUB 515), Family Child Care Consumer Awareness Information (LIC 9212), Blood Glucose Testing Consent/Verification (LIC 9222), Nebulizer Care Consent/Verification (LIC 9166), Acknowledgment of Receipt of Licensing Reports (LIC 9224).

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Unusual Incident/Injury Report (LIC 624B), Child Care Facility Roster (LIC 9040), Property Owner/Landlord Notification (LIC 9149), Property Owner/Landlord Consent (LIC 9149), Entrance Checklist – Family Child Care Homes (LIC 126), Forms/Records to Keep In Your Family Child Care Home (LIC 311D), Safe Sleep Flyer-What Does A Safe Sleep Environment Look Like?, Never Ever Shake A Baby Brochure.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: TANG, ANQI
FACILITY NUMBER: 304314208
VISIT DATE: 08/09/2023
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LPA discussed the safe sleep regulations with the applicant 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. LPAs also informed the 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 their purchased equipment.

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.


The Large Family Child Care Home was not in compliance with Title 22 Regulations at the time of inspection. The applicant is required to submit the following corrections to the licensing office by the due date of

1. CPR and First Aid (Pediatric, EMSA)
2. Cot (will set up and send the picture)

In the event additional requirements are needed, the applicant will be notified. A license will be issued once all requirements are met.

Appeal rights were provided, and an Exit Interview was conducted with applicant Tang Anqi

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, its tools, and methods, please visit the Program Website
at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

End of the Report
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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