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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700221
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:15:44 AM

Document Has Been Signed on 02/14/2023 11:15 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:LI, FENG JUANFACILITY NUMBER:
015700221
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
02/14/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Feng Juan LiTIME COMPLETED:
11:15 AM
NARRATIVE
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On 2/14/2023 at 8:30am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Feng Juan Li for an Announced Capacity Increase Inspection. Present during the inspection was the Licensee, her husband, Li Yen (Alex) Dang and Licensee’s mother, Hui Ming Tan, two (2) infants and one (1) preschool age child. Licensee lives in the home with her fingerprint cleared husband, their three (3) year old son, Licensee’s mother and Licensee’s father Limin Li. The Licensee’s home was then toured for a health and safety inspection. The facility plans to operate from 8:00am – 5:30pm Monday – Friday.

ON LIMITS AREA: Children’s Playroom (Family Room), 1st bedroom on the left (Children’s Nap Room) and Hallway Bathroom and left side of the Backyard
OFF LIMITS AREA: Living Room, Kitchen, Dining Area, 2nd Bedroom on the left, 1st Bedroom on the right with attached Full Bathroom, Garage, Right Side of Backyard
ISOLATION AREA: Nap Room or Children's Play Room

The home has gained a fire clearance on 2/10/2022 from the Fremont Fire Department with the condition of childcare to not permitted in the garage or the shed by the back-sliding door.

The facility is a single-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. Licensee stated that they do not transport children but may in the future. There are no pets and no firearms in the home.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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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Document Has Been Signed on 02/14/2023 11:15 AM - It Cannot Be Edited


Created By: Morgan Pringle On 02/14/2023 at 10:36 AM
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, FENG JUAN
FACILITY NUMBER: 015700221

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2023
Section Cited
CCR
101418(g)

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(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
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Licensee will obtain immunization records for both children and submit copy to LPA Pringle.
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This requirement was not met as evidenced by: Through record review it was found that two infants in care were missing immunization records which poses a potential risk to the health and safety of the children in care
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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:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023


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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, FENG JUAN
FACILITY NUMBER: 015700221
VISIT DATE: 02/14/2023
NARRATIVE
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The home has one (1) fully charged 2A10BC fire extinguisher and a file alarm in the entry way of the home. There is one (1) working combination smoke/carbon monoxide detector in the hallway and all three (3) bedrooms. The home is equipped with central heat and air for proper ventilation. All infant cribs and play yards are clean and in good condition. The fireplace in the family room is blocked by furniture making it inaccessible to children in care. The backyard is fully fenced and well maintained with ample age appropriate materials for the children. There is a fence separating the on and off-limits area. There is a shed and small pergola in the off-limits area. There is also a shed next to the sliding glass door that is used as an office and storage. LPA did not observe any bodies of water in or around the home that could be a potential danger to the children in care.

Licensee’s Health and Safety training with lead component has been completed and Pediatric CPR and First Aid training has expired but will be renewing the training on 2/18/2023. Receipt of registration for the training was provided. Licensee’s Mandated Reporter training is complete and expires 3/9/2024. All adults living in the home have obtained a criminal record clearance. All required forms are posted in the family room. LPA informed Licensee that all postings must be posted in a prominent, publicly accessible area during business hours per California Code of Regulations, Title 22, Section 102419(b). LPA obtained the files for the three (3) children in care and the facility roster. Through record review it was found that two children had incomplete files, including missing immunization records.

Deficiencies Cited During Inspection
  • Two children in care missing immunization records

Licensee was reminded that California Law requires 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 email. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, FENG JUAN
FACILITY NUMBER: 015700221
VISIT DATE: 02/14/2023
NARRATIVE
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Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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-and-resources/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 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 was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LI, FENG JUAN
FACILITY NUMBER: 015700221
VISIT DATE: 02/14/2023
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

Exit interview conducted and report was reviewed with the Licensee Feng Juan Li and her husband. Report was signed and given to Licensee's husband.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC809 (FAS) - (06/04)
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