015700396-8-17-2023-52-CC-BPLY-CUSRHA-20230817130200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700396
Report Date: 08/17/2023
Date Signed: 08/17/2023 01:02:12 PM

Document Has Been Signed on 08/17/2023 01:02 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:	HE, EMILY		FACILITY NUMBER:	015700396
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 5	CENSUS: 4	DATE:	08/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:27 AM
MET WITH:	Emily He- Licensee		TIME COMPLETED:	01:10 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 8/17/23 at approximately 11:27am, Licensing Program Analyst Briana Plumboy, met with licensee Emily He for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 3 infants, 1 preschool age child, and licensee's fingerprint clear and associated assistant/ mother in law Xianxiao Ng. The home was toured to conduct a Health and Safety Inspection. The facility currently operates 7 days a weeks, 24 hours per day. The licensee is aware children in care may not stay in care for over 23 hours. The home is single story. In the back of the home there is another residence and both homes share the yard. Licensee is aware at no time shall the children in care be in direct, unsupervised contact with the tenants or guest at 3816 Seven Hills Rd. The home consists of a living room, kitchen, dining room, 2 bedrooms, 1 master bedroom/master bathroom, and hallway bathroom. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are all bedrooms, dining room, master bedroom/ master bathroom, and kitchen which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, hallway bathroom, and backyard cement area located outside the dining room. The children in care will walk through the dining area with supervision at all times to access the play area in the backyard. The ISOLATION AREA will be the living room. Per licensee the wooden patio and upper deck part of the backyard will be off limits to children in care. Outdoor play area is fenced. There are toys and learning activities. There are no pools, hot tubs or any other bodies of water on the premises. The home has a fully charged 3A40BC 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 3/4/24, and licensee's mother in law's CPR and First Aid certificate is current and expires 12/2/24. The licensee completed and received a certificate in mandated reporter training on 8/16/22, and Xianxiao Ng has a waiver for the mandated reporter training until it is offered in Cantonese. The licensee is in compliance with new immunization law which pertains to day care providers. The home has centralized heating and the fireplace in the living room is electrical and screened. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 6/27/23. The licensee utilizes Lic. 9227 and documents 15 minute safe sleep checks. 3 children's files were reviewed. See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HE, EMILY	FACILITY NUMBER: 015700396
	VISIT DATE: 08/17/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Family Child Care Homes: 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 platforms.

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

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HE, EMILY	FACILITY NUMBER: 015700396
	VISIT DATE: 08/17/2023

NARRATIVE

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The licensee provided proof of control of property.

LPA discussed the safe sleep regulations with and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility.

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 Emily He.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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