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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416748
Report Date: 07/28/2022
Date Signed: 07/28/2022 12:55:51 PM

Document Has Been Signed on 07/28/2022 12:55 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:CHEN, HUI YING & JING KUANFACILITY NUMBER:
013416748
ADMINISTRATOR:CHEN, HUI YING & JING KUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 793-6835
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Hui Ying and Jing Kuan ChenTIME COMPLETED:
01:05 PM
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On July 28th, 2022 @ 9:50am, Licensing Program Analyst (LPA) April Wright met with licensee Hui Ying Chen for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the home by the licensee. There were eleven (11) children present; nine (9) preschool age and two (2) infants and fingerprint cleared spouse Jing Kuan Chen and son Hanlin Chen. Hours of operation are 8:15am - 6:15pm Monday through Friday.

LPA toured the faculty to conduct a health and safety inspection with licensee spouse Jing Kaun Chen. The 2 story home was clean and orderly, with heating and ventilation for safety and comfort of children in care. The isolation area is the living room which is a section away from other children in care.
On limit areas include: Family / day-care room area, bathroom, living room and backyard. Backyard is divided into two (2) sections for infants and preschoolers with play structures that are secure and in good condition. Off-limits areas include: Entire second level of home, kitchen and garage. The off limits areas are and will be made inaccessible by closed and/or locked doors and visual supervision.

There is a gate at the bottom of the stairs to prevent access to the upper level of the home. There are no pools hot tubs or any other bodies of water present. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. There are ample age appropriate toys that appear to be safe and in good condition.

The home has a fully charged 3A40BC fire extinguisher and small 5B-C Kitchen extinguisher, working dual smoke/carbon monoxide detector and telephone. There is a fireplace in that is blocked and inaccessible to children in care. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers.
See LIC809 -C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
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: CHEN, HUI YING & JING KUAN
FACILITY NUMBER: 013416748
VISIT DATE: 07/28/2022
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LPA requested and reviewed the files of eleven (11)) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 3/24/22. The licensee has a current CPR/First aid certificate which expires on 10/30/23 and has completed mandated reporter training on 04/17/2022. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. No IMS provided at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

California Law requires Child Care Centers 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 is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. The licensee was provided information regarding effects of Lead Exposure and testing requirements(Assembly Bill 2370)


See LIC809 -C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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: CHEN, HUI YING & JING KUAN
FACILITY NUMBER: 013416748
VISIT DATE: 07/28/2022
NARRATIVE
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LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also inforned 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.

Licensee was reminded that all adults 18 and over, 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 child care center. 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.

The following deficiencies were observed during today's inspection:

Technical Violation: C2, had no Consent for Emergency Medical Treatment forms (LIC627)



Technical Violation: C1, C4 and C5 did not have Health History (LIC 702) included in their file for review.

A notice of site visit was given and must remain posted 30 days. Exit interview conducted, appeal rights given and report was reviewed with licensee spouse Jing Kuan Chen



SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC809 (FAS) - (06/04)
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