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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700329
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:37:10 PM

Document Has Been Signed on 04/28/2023 02:37 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
OAKLAND SOUTH EAST, 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: 6CENSUS: 5DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Pou Leng "Qiana" LeeTIME COMPLETED:
02:40 PM
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On 04/28/2023 at 12:10pm Licensing Program Analyst (LPA) Christina Uribe and Licensing Program Manager (LPM) Chandra Charles, met with licensee Pou Leng "Qiana" Lee for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 5 daycare children and the fingerprint cleared husband of the licensee, Kent Lee. The licensee is within ratio today. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The LPA and the Licensee, toured the home to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 7:30am-5:30pm.

The home is a single story home with 2 bedrooms, 2 bathrooms, home office, living room, kitchen, attached garage and backyard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort.

The OFF-LIMIT AREAS are the home office, bathroom at the end of the hall and the bedroom at the end of the hall, and garage and are inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the primary bedroom, primary bathroom, living room, kitchen, and backyard.

The facility’s outdoor play space is located in the backyard of the home. The play structure and equipment are all in safe condition free from hazards which could pose a risk to children in care. The fence does have a plank that needs to be replaced that is open to the backyard of the neighboring home. Until the fence plank has been replaced, the licensee is required to provide 100% visual supervision of the children while in the backyard. There is ample shade available and gates are locked at all times while children are in the yard. There are no pools, hot tubs or any other bodies of water present.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide, telephone and fully stocked first aid kit. Per licensee, there are no firearms on the premises or pets in the home.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE, POU LENG
FACILITY NUMBER: 015700329
VISIT DATE: 04/28/2023
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 03/19/24. The licensee is in compliance with the immunization laws and has completed the mandated reporter training on 03/24/22.

The licensee conducts and documents fire and disaster drills at least twice a year and the last conducted drill was on 03/13/23. All required forms are posted and visible for public review.

LPA Uribe reviewed 5 children’s files and personnel records. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. There is a current roster available for review and copy obtained. The facility does have liability insurance which is valid through 07/11/23. Staff interview also conducted and documented.

Incidental Medical Services (IMS) policy was discussed and the facility does not have any children with the need for medication to be kept at the facility at this time. 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.

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 communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

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.

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.

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

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

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE, POU LENG
FACILITY NUMBER: 015700329
VISIT DATE: 04/28/2023
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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.

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.

No deficiencies cited during today's inspection. One advisory note issued:

  • Technical Assistance: There is one plank on the fence in the backyard of the home that is missing and needs to be replaced as it opens into the backyard of the neighboring backyard. Until this plank has been replaced, the licensee will provide 100% supervision to children in care while in the backyard.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Pou Leng "Qiana" Lee.

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

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

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
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