<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700101
Report Date: 12/02/2021
Date Signed: 12/02/2021 01:53:03 PM

Document Has Been Signed on 12/02/2021 01:53 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:XU, BINGJIEFACILITY NUMBER:
015700101
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
12/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Binglie Xu- LicenseeTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/2/21 at 12:20pm, Licensing Program Analyst Briana Plumboy, met with licensee for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 6 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:30am until 5:00pm.

The home is single story. The home consists of a living/ dining room combo, kitchen/dining room combo, family room, 2 bedrooms, 2 bathrooms, and a garage. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the kitchen/ dining room combo, family room, bedroom located on the right side of hallway, bathroom located inside the family room, and garage which will be inaccessible by closed and/or locked doors and visual supervision. There are child safety knobs located on the bedrooms doors and the bathroom door knob located inside the family room. The ON LIMIT AREAS are the living/ dining room combo which is located upon entrance into the home through the front door, the hallway bathroom located between the two bedrooms, and the backyard. As of 12/2/21, the bedroom located on the left side of the hallway is included in the on limits areas. The children will walk through the kitchen and family room to get to the backyard with 100% supervision at all times. The ISOLATION AREA will be dining room portion of the living room. Outdoor play area will be in the fenced backyard which consist of a patio area and upper grass area. There are learning materials and toys that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items which could be accessible to children in care.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is current and expires 07/10/2023. The licensee's mandated reporter training is complete and she received a certification of completion on 01/30/20. The licensee is in compliance with the immunization law which pertains to childcare providers. The fireplace is barricaded to See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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 2
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: XU, BINGJIE
FACILITY NUMBER: 015700101
VISIT DATE: 12/02/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
prevent access by children. The home has floor heaters which have protective covers on them. The floor heaters do not get hot to touch. There is a water heater located inside the garage which is off limits. Per applicant, 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 10/15/21.

6 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.

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 Binglie Xu 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 Binglie Xu 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 Binglie Xu.

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

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2