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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420814
Report Date: 03/29/2022
Date Signed: 03/29/2022 03:07:58 PM

Document Has Been Signed on 03/29/2022 03:07 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HE, FENGFACILITY NUMBER:
013420814
ADMINISTRATOR:HE, FENGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 769-7638
CITY:ALAMEDASTATE: CAZIP CODE:
94502
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Feng HeTIME COMPLETED:
03:15 PM
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On 3/29/2022 Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Feng He for an unannounced random annual inspection at 01:15PM. During visit, Licensee's Daughter was also present. LPA arrived when children were involved in various activities. There are 3 children present today. Records of three children (C1-C3) were reviewed and are complete. The home was toured to conduct a health and safety inspection. The Licensee's hours of operation are Monday-Friday, 8:00AM-6:00PM.

On Limit Areas: living room, dining area, kitchen, bedroom in the front part of the home, bathroom next to this bedroom and the covered patio area next to the kitchen.
All other areas of the home are off limits and are made inaccessible by gate, closed and/or locked doors and visual supervision. Isolation area was discussed with Licensee. The isolation area will be the section of the patio, away from other children in care.

Outdoor Play Area: Outdoor play area has a fully fenced backyard, which is free from defects or dangerous conditions. The section of the yard is used for children and is closed in. The play equipment has cushioning to absorb a fall. There are two storages shed that are made inaccessible to children by locks.

LPAs observed an ample supply of age appropriate toys and activities that appear to be safe and in good condition. LPA did not observe any hazardous items, toxins, or bodies of water accessible to children in care today. LPAs observed that the fireplace and wall heaters are blocked to prevent access by children.

continued on 809-C Page
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HE, FENG
FACILITY NUMBER: 013420814
VISIT DATE: 03/29/2022
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The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, first aid kit and working telephone. Per the licensee, there are no firearms in the home. Per Licensee there are no pets in the home. The licensee's CPR and First Aid certificate is current and expires 06/2023. The licensee conducts and documents fire and earthquake drills at least twice a year, and the log indicates that the last drills were conducted on 03/11/2022. LPA reminded Licensee that the mandated reporter training certificates are to be renewed every two years.

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

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 inspectionprocess@dss.ca.gov. 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.

Licensees 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.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HE, FENG
FACILITY NUMBER: 013420814
VISIT DATE: 03/29/2022
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LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensees 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.

There were no deficiencies in today's visit.

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

Exit interview was conducted and report was reviewed with the Licensee, Feng He

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
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