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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700329
Report Date: 05/20/2022
Date Signed: 05/20/2022 10:01:31 AM

Document Has Been Signed on 05/20/2022 10:01 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:LEE, POU LENGFACILITY NUMBER:
015700329
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Pou "Qiana" Leng LeeTIME COMPLETED:
10:15 AM
NARRATIVE
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On 05/20/2022 at 8:00am, Licensing Program Analyst (LPA) Christina Uribe met with applicant Pou "Qiana" Leng Lee for the purpose of conducting an announced pre-licensing inspection. Present during today’s inspection is the applicant, the applicant’s fingerprint cleared & associated husband, & the applicant's 21-month-old daughter. The home was toured for a health and safety inspection.

On-Limit Areas: Living Room, Kitchen, Bathroom #1, Bedroom #1, Bedroom #2, & Backyard.

Off-Limit Areas: Primary Bedroom, Primary Bathroom, & Garage.

The facility is a single story home consisting of 3 bedrooms, 2 bathrooms, living room, kitchen, & garage which are neat and clean with heating and ventilation for safety and comfort. The off-limits areas will be made inaccessible by closed and/or locked doors, child safety gates, & visual supervision. The isolation area is Bedroom #1. The living room will be used as the primary daycare space.

Backyard: The outdoor play area is located in the applicant’s backyard and is fully fenced and in good condition with no hazardous materials accessible to children in care. There are no pools, hot tubs, or any other bodies of water present during today’s inspection.

There are ample age-appropriate toys that appear to be safe and in good condition. The home is equipped with a fully charged 3A40BC fire extinguisher, functional carbon monoxide detector, smoke detector, & telephone. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

FIREPLACE: There is a fireplace located in the on-limit kitchen that is barricaded to prevent accessibility to children in care.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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 3
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: LEE, POU LENG
FACILITY NUMBER: 015700329
VISIT DATE: 05/20/2022
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Per licensee, there are no firearms or pets in the home during today’s inspection. The applicant is in compliance with the immunization laws which pertain to all childcare providers. Applicant completed and received certificates for Mandated Reporter Training & Pediatric CPR/First-Aid Training and was reminded of their responsibility to renew each training every two years.

Records to be Maintained: LPA reviewed the Packet of Records to be Maintained with applicant and thoroughly discussed each page and section for clarification and consultation. Applicant understands their responsibility for maintaining personnel and children's records, keeping complete and separate records for each child, and making them available for review upon request to the Licensing Department. LPA reviewed Personal Rights, Parents' Rights, Reporting Requirements, & Inspection Authority with the applicant. At this time, applicant does not have Liability Insurance.

PROVIDING IMS: This facility does not plan on providing Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department.

LPA informed applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Baby bouncers & drop-down cribs are not allowed at the daycare facility. Roster of children & their records must be properly maintained & available for review at all times. A fire/disaster drill must be performed and recorded every 6 months. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to the Community Care Licensing. The licensee was provided information regarding the effects of Lead Exposure and testing requirements (Assembly Bill 2370).

Applicant 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.

Page 2 of 3 ***Continue on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: LEE, POU LENG
FACILITY NUMBER: 015700329
VISIT DATE: 05/20/2022
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Effective August 1, 2003 California Law requires Child Care 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 to the regional office by phone and the written report, LIC 624, within 7 business days.

This home is recommended for Licensure on 05/20/2022. This report shall remain on file for 3 years. Exit interview was conducted with applicant, Pou "Qiana" Leng Lee.

Licensing Program Analyst Contact Information: Christina Uribe

Address: 1515 Clay St, Suite 1102, Oakland, Ca 94612
Office: 510-622-2602
Direct: 510-363-5461
christina.uribe@dss.ca.gov

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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