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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700332
Report Date: 03/15/2022
Date Signed: 03/15/2022 10:04:00 AM

Document Has Been Signed on 03/15/2022 10:04 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:HE, YI ROUFACILITY NUMBER:
015700332
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yi Rou HeTIME COMPLETED:
10:15 AM
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On 3/15/22 at 9:00am, Licensing Program Analyst Briana Plumboy, met with licensee Yu Rou He for an ANNOUNCED CHANGE IN LOCATION/PRE LICENSING INSPECTION. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:00am until 6:00pm. The Family Childcare Home is located at its own address at 4363 James Ave. Castro Valley, CA 94546 behind 4365 James Ave. Castro Valley, CA 94546. Both homes are on the same lot and owned by the licensee. To enter the childcare, licensee stated families will be let in the side gate and walk to the home located in back of the front house.
The front home consist of 3 master bedrooms with master bathrooms, a hallway bathroom, a living room, dining room, and lower level of the home which consist of 3 rooms. Per licensee at no time will the children in care be inside the front house located at 4365 James Ave. The back home located at 4363 is designed for children in care. The home consist of a bathroom with 2 sinks, a small room located through the door on the right of the bathroom, a living room, a kitchen, a bedroom located off the kitchen, and a second bedroom located through the first room. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the small room located to the right of the bathroom, the kitchen, and the back room which will be inaccessible by closed and/or locked doors and visual supervision. There is a child safety gate in place to prevent access to the kitchen. The ON LIMIT AREAS are the bathroom, living room, and bedroom located next to the kitchen. The ISOLATION AREA will be the first bedroom located next to the kitchen. Outdoor play area will be in the fenced backyard which has its own sink. The childcare has its own backyard which can be located through the living room. The outdoor area located between the front and back home will not be utilized by children in care except when the licensee or families in care are dropping off or picking up the children in care. The garden located on the right of the back backyard will not be utilized by children in care. There are toys that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's Health and Safety training is completed and CPR and First Aid certificate is current and expires 04/17/23. The licensee is in compliance with new immunization law which pertains to day care providers.
See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
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: HE, YI ROU
FACILITY NUMBER: 015700332
VISIT DATE: 03/15/2022
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The licensee currently has a waiver for mandated reporter training until it is available in Cantonese. The home has centralized heating and each room's heat can be monitored at different temperatures. Per licensee, there are no firearms in the home. A copy of the mortgage statement was reviewed and shows control of property.
The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

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 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 Yi Rou He 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 Yi Rou He 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.

This home is recommended for licensing on 3/15/22. This report shall remain on file for 3 years. Exit interview conducted applicant.

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

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC809 (FAS) - (06/04)
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