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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421948
Report Date: 06/10/2021
Date Signed: 06/10/2021 10:22:25 AM

Document Has Been Signed on 06/10/2021 10:22 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:MA, JINGFACILITY NUMBER:
013421948
ADMINISTRATOR:MA, JINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 368-3911
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
06/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jing Ma- LicenseeTIME COMPLETED:
10:30 AM
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On 06/10/21, Licensing Program Analyst Briana Plumboy, met with licensee Jing Ma for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was 11 preschool age children, 1 school age child (licensees daughter who is not in included in the licensee's ratio), licensee's fingerprint clear and associated Zhigang Zhang and assistants Yanhong Li and Ruomei Ma. The home was toured to conduct a Health and Safety Inspection. This facility currently operates Monday through Friday from 7:00am until 6:00pm.

The home is a two story home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room which is converted into a classroom, kitchen, dining room, family room which has been converted into a playroom, the bathroom which is located 3 stairs down from the family room and has a barricade to prevent access to the stairs, and the deck in the yard. The OFF LIMIT AREAS are the entire second level of the home and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREAS are corners in the living room and family room. The stairs which lead to the second level of the home have a gate barricade located at the bottom, and there are barricades located throughout the on limit areas at the entrances and exits. The BACKYARD play area is fenced. The children only play on the deck in the yard and there is a gate on the stairs which lead to the entrance of the deck. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensees CPR and First Aid certificate is current and expires 05/01/23. The licensee Ms. Jing Ma and the assistants present today is in compliance with the provider immunization law. Licensee Jing Ma currently has a waiver for the mandated reporter training certificate until it is available in Mandarin. Licensee is aware once the mandated reporter training is available in Mandarin, herself and assistants must complete the training and receive certificates of completion. Per licensee, there is a firearm in the home but it is stored in an off limit area and the ammunition is stored separate. This facility has current Daycare insurance. The licensee conducts and documents fire/disaster drills with the last one conducted on 05/03/21.
The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2021
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: MA, JING
FACILITY NUMBER: 013421948
VISIT DATE: 06/10/2021
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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home 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 was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.



No deficiencies cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
LIC809 (FAS) - (06/04)
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