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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423295
Report Date: 08/16/2022
Date Signed: 08/16/2022 11:32:57 AM

Document Has Been Signed on 08/16/2022 11:32 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:YU, GUOCHUANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 367-0118
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:YU, GUOCHUANGTIME COMPLETED:
11:19 AM
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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 2 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 is current and will expire in June 2023. (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 June 2022. 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: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
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: YU, GUOCHUANG
FACILITY NUMBER: 013423295
VISIT DATE: 08/16/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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 encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.


There are no deficiencies cited today. Exit interview conducted with Guochuang Yu. This report shall remain on file for 3 years.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
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