435700360-5-19-2023-52-CC-MESA-CRYR3V-20230519124033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700360
Report Date: 05/10/2023
Date Signed: 05/19/2023 12:40:43 PM

Document Has Been Signed on 05/19/2023 12:40 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	LAI, CAI XIA		FACILITY NUMBER:	435700360
ADMINISTRATOR:	LAI, CAI XIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 695-9982
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Cai Xia Lai and Sandy Lai		TIME COMPLETED:	03:15 PM

NARRATIVE

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On Wednesday, May 10, 2023, at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted unannounced Required 1 Year Visit. LPA met with the Licensee Cai Xia Lai, Licensee's daughter/assistant provider Sandy Lai and explained the nature of the site visit. Present on this visit were Licensee's daughter/assistant provider Sandy Lai, Licensee's assistant provider Ting Zhang and her daughter, 4 infant children, 8 preschool children and 1 adult living in the home (Kwun Chan). The home operates from Monday to Friday 8:30 AM to 6 PM.

The home was toured to conduct a Health and Safety Inspection with the Licensee and Licensee's daughter. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort.
The On-Limit Areas are the Play Area (Napping Area), Play Area (Living Room), Lunch Area, Bathroom on the first level next to the Lunch Area and the Backyard. The designated isolation area is the Play Area (Living Room). The backyard will be a designated outdoor play area that is fully fenced. The outdoor area has age-appropriate toys that appear to be clean and free from defects and dangerous conditions. There are no pools, hot tubes, or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible.

The Off-Limit Areas are the entire second floor, the kitchen, and the garage. LPA reminded the Licensee that the Off-Limit Areas will be inaccessible to children by locked doors, safety gates and visual supervision.

The home has a fully charged fire extinguisher 2A10BC, working smoke detector, carbon monoxide, telephone (cell phone). As per the Licensee, there are no firearms on the premises. The home does have a fireplace that is screened to prevent access to children.

See LIC 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LAI, CAI XIA	FACILITY NUMBER: 435700360
	VISIT DATE: 05/10/2023

NARRATIVE

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Continuation.

The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 02/20/2023. Licensee owns the house and has childcare liability insurance with DCI Insurance (renewal date 10/10/2022. Licensee stated that she does not transport children at this time

Licensee and Licensee assistant provider have current records of Measles and Pertussis immunization, Influenza vaccination and TB clearance, CPR and First Aid certificate and andated Reporter Training Child Care Providers Certificates. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, LIC 9227, Sleep Logs and Immunization. The licensee is in ratio today.

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

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.

SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LAI, CAI XIA	FACILITY NUMBER: 435700360
	VISIT DATE: 05/10/2023

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Continuation.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

LPA discussed and provided a copy to the Licensee of the American Rescue Plan Act Survey.

LPA Estoesta informed licensee that this report dated 05/10/2023 documents (1 Type B citation) which poses a potential risk to the health, safety, or personal rights of children in care.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Cai Xia Lai.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/19/2023 12:40 PM - It Cannot Be Edited

Created By: Manel Estoesta On 05/10/2023 at 02:46 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: LAI, CAI XIA	FACILITY NUMBER: 435700360
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102370(d)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:20 pm, on record review, Staff Ting Zhang did not have a criminal record clearance. Staff Ting Zhang started in the home on 04/19/2023. Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/12/2023
	Plan of Correction
1 2 3 4	The Licensee will request a criminal record clearance for the Staff Ting Zhang on or before 05/12/2022 and will submit a proof to LPA Estoesta via mail.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jason Jang

LICENSING EVALUATOR NAME:

Manel Estoesta

LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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