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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423295
Report Date: 06/22/2021
Date Signed: 06/22/2021 10:21:33 AM

Document Has Been Signed on 06/22/2021 10:21 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:YU, GUOCHUANGFACILITY NUMBER:
013423295
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Yu, GuochuangTIME COMPLETED:
10:30 AM
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On June 22, 2021, Licensing Program Analyst Sidney Cortez, met with licensee GUOCHUANG YU for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee YU GUOCHUANG, and his fingerprinted employee XIAOJUAN TAN. Present also are 4 kindergarten age children (less than age of 3). The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:00AM until 6PM, MONDAY-FRIDAY.The home is single story, which is neat and clean with heating and ventilation for safety and comfort. The home consists of three bedrooms and 2 bathrooms, living room, dining room, kitchen, and backyard. The OFF LIMIT AREAS will be the bedroom/bathroom through the kitchen, the first bedroom on the right of the hallway, the bedroom to the left of the hallway, the garage, the storage area and shed in the backyard, and the left side of the backyard that is blocked by a gate. All off limit areas are inaccessible by gate, closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, the dining room/play area, the backyard and the second bedroom on right side of the hallway, and the hallway bathroom. The ISOLATION AREA will be the smaller couch in the living room furthest away from the play area. The outdoor play area will be in the backyard area of the home, which is fenced in. The outdoor play area is free from defects. There are two storage buildings in the backyard, which will be locked and inaccessible to children. The second bedroom on the right side of hallway will be the napping room which has a bed and two cribs. There are ample age appropriate toys that are safe and observed to be clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPAs did not observe any hazardous materials or toxins accessible to children today.The home has a fully charged (2A10BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (March 2023). The licensee's mandated reporter training is pending, and needs to be completed (will issue a technical advisory/violation). According to he Licensee will complete it this week. (STATE IF LICENSEE IS IN COMPLIANCE WITH THE NEW IMMUNIZATION LAW) Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on Feb 4, 2021. 3 Children files were reviewed, facility roster reviewed and copy obtained. 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: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2021
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: YU, GUOCHUANG
FACILITY NUMBER: 013423295
VISIT DATE: 06/22/2021
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LPA Cortez provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee


LPA Cortez provided licensee with a copy of the CDSS handout on Effects of Lead Exposure and Never Shake a Baby Brochure (attached PUB 271). 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. This entire report has been read to the Licensee by LPA Cortez. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Cortez or CCLD.




There are no deficiencies cited. 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: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC809 (FAS) - (06/04)
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