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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423029
Report Date: 01/20/2022
Date Signed: 01/21/2022 04:05:24 PM

Document Has Been Signed on 01/21/2022 04:05 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:HU, XIUFANGFACILITY NUMBER:
013423029
ADMINISTRATOR:HU, XIUFANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 206-9096
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
01/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Xiufang Hu- LicenseeTIME COMPLETED:
12:25 PM
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On 1/20/22 at 10:15am, Licensing Program Analysts Briana Plumboy and April Wright, met with licensee Xiufang Hu for an UNANNOUNCED ANNUAL REQUIRED 1 YEAR INSPECTION. Present for this visit was 3 infants, 6 preschool age children, licensee's 2 school age children, fingerprint clear and associated assistant Xiaofen Wu, and licensee's fingerprint clear and associated husband Guorong Chen. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am until 6:00pm.
The home is single story. The home consists of 8 rooms. The home is neat with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the two bedrooms located against the back wall, the laundry room and bathroom located off the kitchen, and the back half of the backyard which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, the first bedroom on the right side of the hallway, the hallway bathroom, the kitchen/dining room combo, and the front half of the backyard. The ISOLATION AREA will be the first room located on the right side of the hallway. Outdoor play area will be in the first half of the fenced backyard. There is a garage/storage unit located inside the backyard which is off limits to children in care. There are toys and learning activities.
There is a 2A10BC fire extinguisher, carbon monoxide detector, pull down fire alarm, and smoke detector which meet State Fire Marshall standards during today's inspection.
There are no pets in the home. All required licensing documents are posted and visible for public review. The licensee's Pediatric CPR/First Aid certificate is current and expires 07/11/22 and licensee's assistant Xiaofen Wu's is current and expires 1/1/24. Licensee's mandated reporter training was completed on 02/18/20 and her assistant Xiaofen's expires 11/16/21. Licensee and her assistant Ms.Wu are compliance with the immunization law. The licensee possesses current day care insurance and provided LPAs with a copy of her policy. Per licensee, there is no longer a firearm in the home. The licensee documents fire and disaster drills with the last conducted on 12/1/21.
(5) Children files were reviewed. At 11:52am, licensee provided a copy of the Lic. 9040 to LPAs and it was reviewed for completeness. 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: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
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: HU, XIUFANG
FACILITY NUMBER: 013423029
VISIT DATE: 01/20/2022
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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 Xiufang Hu 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 Xiufang Hu 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 Xiufang Hu.

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

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
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