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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421214
Report Date: 08/17/2022
Date Signed: 08/17/2022 11:17:06 AM

Document Has Been Signed on 08/17/2022 11:17 AM - 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:HE, FENGFACILITY NUMBER:
013421214
ADMINISTRATOR:HE, FENGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 334-1337
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/17/2022
TYPE OF VISIT:Annual/RandomANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Licensee, Feng He, and daughter Yanxia Ma TIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, He feng and her daughter Yanxia Ma for Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee and her daughter. Licensee’s primary language is not English. Licensee’s daughter Yanxia Ma helped in translate. The facility has had an inactive status for the last year. Licensee has planned to go on Active Status effective today, 08/17/2022. The home is a one story house consisting of 4 bedrooms, 2 bathrooms, living room, kitchen, dining area, backyard and garage. The hours of operation are 8:00AM- 6:00PM, Monday -Friday. The facility has liability insurance through West Chester company.

ON LIMIT AREAS are the day care room, playroom, dining room, bathroom located at end of the hallway, and backyard. The OFF-LIMIT AREAS are master bedroom/bathroom, 3 bedrooms located in the hallway, kitchen, sides of the backyard and garage which will be inaccessible by closed and/or locked doors and visual supervision.

LPA inspected the house for health and safety hazards. Day-care Area is clean, orderly, and equipped with age appropriate toys and equipment for children, indoors and outdoors. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or Fireplace in the Day-care area. The licensee has closed the fireplace permanently in the day care area. There are child size tables and chairs for snack and activities. There are ample of age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The Facility has a cots in good condition and each child will have their separate blankets. Licensee states there are no guns or weapons of any kind in the home. Licensee have valid CPR. Licensee provides daily snacks and meals. Discipline policy is redirection. All required postings are properly posted.
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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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 2
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: HE, FENG
FACILITY NUMBER: 013421214
VISIT DATE: 08/17/2022
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During Inspection, 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.

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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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.

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

Exit interview conducted and report was reviewed with the licensee He Feng and her daughter Yanxia Ma.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
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