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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421632
Report Date: 02/01/2022
Date Signed: 02/01/2022 12:36:38 PM

Document Has Been Signed on 02/01/2022 12:36 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:HE, YI ROUFACILITY NUMBER:
013421632
ADMINISTRATOR:HE, YI ROUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 867-7369
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
02/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Yi Rou HeTIME COMPLETED:
12:45 PM
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On 2/1/22 at 11:38am, Licensing Program Analyst Briana Plumboy met with licensee Yi Rou He for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was 2 infants, 8 preschool age children, and assistants Huanchi Dong and Lian Xi Xu. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:00am until 6:00pm.
At 11:38am, LPA toured the home upon entry with licensee. The home is a single story home. The assistants enter and exit the facility through the sliding door located inside the middle room, using the side gate which leads to the front of the home. The home appears to be neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, center bedroom, kitchen, dining room, hallway bathroom, master bedroom, and backyard. The OFF LIMIT AREAS will be the the master bathroom, the bedroom located off the left of the hallway bathroom, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. Licensee is aware children may not utilize off limit areas for any REASON. The ISOLATION AREA will be the master bedroom. The BACKYARD play area is fenced. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present in the home during today's inspection. All toxins are kept out of the reach of children and it was observed that there are no toxins accessible to children during today's inspection.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and her mother Lian Xi Xu's CPR and First Aid certificate are current and expires 04/17/23. The licensee, her assistant Huanchi Dong, and her assistant Lian Xi Xu are in compliance with the immunization law. The fireplace is located in the living room and blocked by a barricade to prevent access by children. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 8/5/21. The licensee is in ratio today. A copy of the roster was provided to LPA. All REQUIRED forms are posted and visible for public review. The licensee has current Day Care Insurance. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2022
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: HE, YI ROU
FACILITY NUMBER: 013421632
VISIT DATE: 02/01/2022
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Incidental Medical Services (IMS) policy was discussed. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Yi Rou He 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 Yi Rou He 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Yi Rou He.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC809 (FAS) - (06/04)
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