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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700221
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:58:50 AM

Document Has Been Signed on 05/30/2023 11:58 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:LI, FENG JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 601-7354
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
05/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Feng Juan LiTIME COMPLETED:
11:58 AM
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On 5/30/2023 at 10:10am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Feng Juan Li for a Required – 1 Year Inspection. Present during the inspection was the Licensee, her husband, her mother-in-law, who is her helper, her father-in-law, licensee’s three (3) year old son and two (2) infants. Licensee lives in the home with her husband, their three (3) year old son, and her in-law’s. Licensee’s home was toured for a health and safety inspection. The facility operates from 8:00am – 5:30pm, Monday - Friday.

ON LIMITS AREA: Children’s Playroom (Family Room), 1st bedroom on the left (Children’s Nap Room), Hallway Bathroom and left side of the Backyard
OFF LIMITS AREA: Living Room (only used by licensee’s son), 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 Playroom

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: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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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: 05/30/2023
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The home has one (1) fully charged 2A10BC fire extinguisher and a fire alarm in the entry way of the home. There is one (1) working combination smoke/carbon monoxide detector in the hallway and the children’s nap room. The home is equipped with central heat and air for proper ventilation. There are two (2) cribs and two (2) play yards (pack-n-plays) that are clean and in good condition. LPA observed all bedding is clean and in good condition. Licensee occasionally uses highchairs and booster chairs for younger infants for meal times. The fireplace in the family room is blocked by bookshelves 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 poisoning component has been completed. Licensee’s Pediatric CPR and First Aid training's have been completed and expire 2/18/2025. Licensee’s Mandated Reporter training is complete and expires 3/9/2024. Licensee has until 8/6/2023 to conduct their first fire/disaster drill as their first enrolled child’s start date is 2/6/2023. All adults living in the home have obtained a criminal record clearance. All required forms are posted and visible for public view in the entry way of the home. LPA obtained the children’s files and facility roster. All files were complete.

No deficiencies were cited during this inspection.

Licensee was reminded that California Law requires Licensee 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. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
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: LI, FENG JUAN
FACILITY NUMBER: 015700221
VISIT DATE: 05/30/2023
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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 was reminded that all adults 18 and over living or working in the home, 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.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with Licensee Feng Juan Li.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
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