<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700332
Report Date: 02/15/2023
Date Signed: 02/15/2023 06:54:43 PM

Document Has Been Signed on 02/15/2023 06:54 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HE, YI ROUFACILITY NUMBER:
015700332
ADMINISTRATOR:HE, YI ROUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 867-7369
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Yi Rou He- LicenseeTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/15/23 at 2:54pm, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Case Management Inspection with Licensee Yi Rou He. Present for the inspection was 11 children in care as well as fingerprint clear assistants Huanchi Dong and Lian Xi Xu. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 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 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, pull down fire alarm, 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 and both assistants are in compliance with new immunization law which pertains to day care providers. The licensee and both assistants currently have waivers for mandated reporter training until it is available in Cantonese. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 1/30/23. The licensee is in ratio today. A copy of the roster was provided to LPA. All REQUIRED forms are posted and visible for public review. The licensee has current Day Care Insurance. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 2
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: 02/15/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. 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.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Yi Rou He.

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

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2