015700381-3-13-2023-52-CC-MESA-CPVRKR-20230313130557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700381
Report Date: 03/13/2023
Date Signed: 03/13/2023 01:06:07 PM

Document Has Been Signed on 03/13/2023 01:06 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:	SU, HANG		FACILITY NUMBER:	015700381
ADMINISTRATOR:	SU, HANG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 474-8147
CITY:	NEWARK	STATE: CA	ZIP CODE:	94560
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	03/13/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Hang Su		TIME COMPLETED:	01:00 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 Monday, March 13, 2023 at 11 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an announced Pre-licensing Visit. LPA met with the Applicant Hang Su and explained the nature of site visit. Present on this visit was the Applicant's oldest four year old son and Applicant's father in law. The applicant submitted a Family Child Care Home (FCCH) Large License Application and received in the Regional Office on 08/17/2022. Fire Clearance on 03/01/2023. The home plans to operate from Monday to Friday from 8:30 am to 6 pm. LPA toured the home to conduct a Health and Safety Inspection with the Applicant. The home is a one-story home. The home is neat and clean with central heating and ventilation for safety and comfort. The On-Limit Areas are the Front Yard, Classroom, Kid's Bathroom (next to the kitchen), Sunroom and Backyard. The front yan and backyard will be a designated outdoor play area that is fully fenced and or need to have visual supervision. The home does have a fully charged 3A40BC fire extinguisher, working smoke detector and carbon monoxide and working mobile phone. The Sunroom and or Bedroom number 2 are the designated Isolation Area when a child gets sick. The Off Limit Area are the Kitchen, Bedroom number 1, the Bedroom number 2 (Office room), Bedroom number 3, Side Yard (left side when facing the house) and the Garage. LPA discussed to the applicant that the Off Limit Areas will be inaccessible to children by locked doors, safety gates and visual supervision. The applicant owns the home and LPA reviewed the Proof of Ownership (Grant Deed dated 01/25/2022) with the Applicant. SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: SU, HANG	FACILITY NUMBER: 015700381
	VISIT DATE: 03/13/2023

NARRATIVE

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Continuation....

The applicants completed the Health and Safety training completed on 01/14/2018, and CPR (Pediatric) and First Aid completed on 02/19/2022 with validity period of 2 years. The applicants completed the AB1207 Child Care Providers training online on 06/12/2021 at https://mandatedreporterca.com/. LPA reminded the applicant that AB1207 requires 2-year renewal. The applicant has records of Measles and Pertussis immunization, Influenza declination statement and TB clearance. LPA reminded the applicant that only the Influenza vaccination can be decline with a written declination.

LPA reviewed with the applicant the Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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

LPA discussed the safe sleep regulations with the 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 the 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.

LPA discussed to the applicant about the Resources for Providers CDSS Programs Community Care Licensing Child Care Program Website and Child Care Resource and Referral Agencies R&Rs, Guardian website and Inspection Authority of the Department.

SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

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: SU, HANG	FACILITY NUMBER: 015700381
	VISIT DATE: 03/13/2023

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Continuation.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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 information communication platform.

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

The home is recommended for a Large FCCH License as of today, Monday, March 13, 2023.

Exit interview conducted and report was reviewed with the applicant, Hang Su.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC809 (FAS) - (06/04)

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