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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422269
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:25:29 PM

Document Has Been Signed on 12/13/2022 01:25 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:LI, WEI MINGFACILITY NUMBER:
013422269
ADMINISTRATOR:LI, WEI MINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 407-2878
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Wei Ming LiTIME COMPLETED:
01:40 PM
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On 12/13/2022 approximately at 11:35AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Wei Ming Li. Present for this inspection was just the licensee. No children were present today. Per licensee, she does not have any children of her own, however she does have two other individuals ("tenants") residing at the home who are also fingerprinted. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care will be Monday through Friday, 8:30am to 6:30pm.

ON LIMITS: Living room, dining room (isolation area), and kitchen
OFF LIMITS: garage, front and back yard, all 4 bedrooms, 2 bathrooms, and laundry room. Off limit areas are inaccessible by closed and/or locked doors, and visual supervision.

The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. At 11:45AM, LPA observed there were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There is a fully charged 2A10BC fire extinguisher, working carbon monoxide, smoke detectors, and telephone. The home does not have a fireplace, however wall heaters are blocked with a secure barrier. Per licensee, there are no firearms or pets or smoking at the home. The licensee conducts and documents fire drill log indicates a drill was conducted 06/18/21. LPA advised licensee to conduct a fire drill once every 6 months. Licensee understood. All other required licensing documents are posted and visible for public review. Per licensee, children would eat, sleep, and use the "potty chair" in the living room area; Play pens would be placed in each corner to maintain COVID restrictions. Licensee also mentions that she would sometimes use mats and/or mattresses for children who occasionally come during the summer or vacation time.

SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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 3
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: LI, WEI MING
FACILITY NUMBER: 013422269
VISIT DATE: 12/13/2022
NARRATIVE
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At 12:20PM, 6 children's files were reviewed from last year and found to be complete. The facility roster was reviewed, and a copy obtained; per licensee she does not have any newly enrolled children. Licensee has proof of MMR vaccine, however licensee does not have proof of pertussis or whopping cough vaccine. Licensee states that she would ask her primary doctor for records and does not usually get a flu shot. LPA advised licensee to have a declaration letter if flu shot is not given each year. Mandated reporter training is completed as of 11/06/2021. CPR and First Aid training are also current as of 10/15/2022 to 10/01/2024. LPA also advised licensee to continue to use sleep logs mentioned during last year's inspection; per licensee, she does not have any sleep logs to review today as all the children previously enrolled are over 2 years old, however she understands the importance of conducting and maintaining sleep checks every 15 minutes regulated by Safe Sleep requirements. Per licensee, she is in the process of accepting children as of today.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Wei Ming Li

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.

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, WEI MING
FACILITY NUMBER: 013422269
VISIT DATE: 12/13/2022
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Incidental Medical Services (IMS) policy was discussed. This facility does not provides IMS to children in care. 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 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.


Licensee was reminded that California Law requires licensed Child Care Centers 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. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting 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/process.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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