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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422269
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:47:56 PM

Document Has Been Signed on 11/29/2023 02:47 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
OAKLAND SOUTH CC RO, 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: 2CENSUS: 1DATE:
11/29/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Wei Ming LiTIME COMPLETED:
03:00 PM
NARRATIVE
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On 11/29/2023 at 12:30PM Licensing Program Analyst (LPA) Jaleesa Jackson arrived at for an Unannounced Required Inspection, and met with Licensee Wei Ming Li. Present for this inspection was the licensee, 2 fingerprint cleared adults, and 1 school aged child. Currently residing in the home are the licensee and 3 fingerprint cleared adult tenants. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care will be Monday through Saturday, 9:00AM to 6:00PM.

ON LIMITS: Living room, dining room (isolation area), Bathroom #1 (first door left of hallway) and kitchen
OFF LIMITS: garage, front and back yard, all 4 bedrooms, 1 bathroom, 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 12:30PM, LPA observed there were ample age appropriate toys that were observed to be safe and in good condition. LPA observed that a bathroom was made on limits without notifying department beforehand. LPA reminded Licensee to notify any area going from off limits to on limits needs department approval visit first. LPA also observed in the hallway leading to the bathroom an uncovered open faced heater. LPA let Licensee know that this needs to be covered since children need to pass by it to use the restroom. There is a fully charged 2A10BC fire extinguisher, working carbon monoxide, smoke detectors, and telephone. Licensee stated there are no firearms or pets or smoking at the home.

Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, WEI MING
FACILITY NUMBER: 013422269
VISIT DATE: 11/29/2023
NARRATIVE
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At 1:00PM, 2 children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. CPR and First Aid training are also current as of 10/15/2022 to 10/01/2024. The licensee conducts and documents disaster drills. The last drill was conducted 11/8/2023. All other required licensing documents are posted and visible for public review.

There were 2 deficiencies cited on today's visit. See 809-D.

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.

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 webpage 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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/.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, WEI MING
FACILITY NUMBER: 013422269
VISIT DATE: 11/29/2023
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Wei Ming Li, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Wei Ming Li.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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Document Has Been Signed on 11/29/2023 02:47 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 11/29/2023 at 02:12 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LI, WEI MING
FACILITY NUMBER: 013422269

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observationrecord review, the licensee did not comply with the section cited above one side of open faced heater was not screened which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2023
Plan of Correction
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Licensee with screen the other side of open faced heater and send a picture to LPA by email by POC date.
jaleesa.jackson@dss.ca.gov
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observatio record review, the licensee did not comply with the section cited above one room was made on limits without notifying the department which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2023
Plan of Correction
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Licensee will write a statement acknowledging any changes or alterations including making a new area of the home on limits will be notified to the department before use.
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:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023


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