<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421890
Report Date: 05/15/2024
Date Signed: 05/15/2024 02:50:02 PM

Document Has Been Signed on 05/15/2024 02:50 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:ZHU, CHANGFACILITY NUMBER:
013421890
ADMINISTRATOR/
DIRECTOR:		ZHU, CHANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 499-7768
CITY:ALAMEDASTATE: CAZIP CODE:
94502
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:42 AM
MET WITH:Chang ZhuTIME VISIT/
INSPECTION COMPLETED:
02:57 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/15/2024 at 11:32am, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Chang Zhu for an Unannounced Random Inspection. Present during the inspection were four infants and three preschoolers in care and an additional three fingerprint cleared staff members. Residing in the home is Licensee and her finger print cleared father . Licensee’s home was toured for a health and safety inspection. The facility operates 8:00am – 6:00pm, Monday - Friday.

The home is a single story house that consists of three bedrooms and two bathrooms. The entrance to the day care is the front door. The inside and outside of the home were observed to be neat, clean with age-appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection LPA observed the following precautions there is a fireplace that has been blocked with a cover, and most of the off limit areas are blocked off. Licensee stated there are no firearms or pets in the home. LPA did not observe a body of water in or around home.

ON LIMITS AREA: The sun room that is the main area of the day care, the family room next to the kitchen, both bathrooms, the hallway leading to the family room, the bedroom on the right side of the home (nap room), and the areas fenced in backyard that includes only the back area.
OFF LIMITS AREA: The two bedrooms on the left side of the house, the kitchen, the living room, the left and right side of the backyard and the laundry area next to the sun room, which will be inaccessible by closed and/or locked doors or visual supervision.
ISOLATION AREA: in the nap room

REPORT CONTINUES ON 809C.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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 7
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: ZHU, CHANG
FACILITY NUMBER: 013421890
VISIT DATE: 05/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The home has a fully charged 3A40BC fire extinguisher located in the kitchen and a push button alarm located in-between the family room and the living room. Licensee has a working telephone, and all required forms are posted and visible for viewing by the front door. The Licensee's CPR and First Aid certificate is current and expires on 11/25. The Licensee was reminded of the responsibility as a mandated reporter and will provide proof of the required training for all people caring for children. LPA reviewed five children’s files and all present staff files and obtained a current facility roster.

At 11:46am LPA Fernandes tested the carbon monoxide detector, which was not working. When removed from the wall there were no batteries. LPA Fernandes then asked for the smoke detector which was placed in a cabinet above the refrigerator when tested there were no batteries. Licensee placed batteries in both detectors which both kept beeping. LPA reminded the Licensee the importance of checking the detectors and that both need to be replaced due to the age.

At 1:02pm, while conducting a record review three out of the four staff members did not have a complete file and four out of four did not have current mandated reporter training. There were no current disaster drills, which need to be conducted once every six months. The last drill was conducted 9/2023.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

REPORT CONTINUES ON 809C.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: ZHU, CHANG
FACILITY NUMBER: 013421890
VISIT DATE: 05/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Zhu, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.


The following copies are need for the facility file:
- Updated LIC610A Emergency Disaster
- Immunization for all living in the home

See 809D for deficiencies sited during today’s inspection.


A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee
Appeal rights, report and Notice of site visit provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 05/15/2024 02:50 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 05/15/2024 at 01:20 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHU, CHANG
FACILITY NUMBER: 013421890

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above the carbon monoxide detector did not have batteries and does not work which poses a potential health risk to persons in care.
POC Due Date: 05/22/2024
Plan of Correction
1
2
3
4
Licensee will get a working carbon monoxide and smoke detector and send a video of testing to CCLD by POC date.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above no current documented drills were conducted which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/22/2024
Plan of Correction
1
2
3
4
Licensee will conduct a drill and send proof of documentation to CCLD by POC date.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 05/15/2024 02:50 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 05/15/2024 at 01:20 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHU, CHANG
FACILITY NUMBER: 013421890

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and conformation, the licensee did not comply with the section cited above in four out four staff did not have a current certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/29/2024
Plan of Correction
1
2
3
4
Licensee will provide proof of completed Mandated Reporter training and write a statement of understanding to CCLD by POC date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above staff was missing immunization's which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/29/2024
Plan of Correction
1
2
3
4
Licensee will submit proof of immunization or a written plan to CCLD by POC date.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7