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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700396
Report Date: 07/11/2024
Date Signed: 07/11/2024 01:18:46 PM

Document Has Been Signed on 07/11/2024 01:18 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, EMILYFACILITY NUMBER:
015700396
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
07/11/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Emily He- LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 7/11/24, Licensing Program Analyst Briana Plumboy, met with licensee Emily He for an UNANNOUNCED CASE MANAGEMENT INSPECTION for the purpose of a CAPACITY INCREASE. Present for this visit was 1 infant, 4 preschool age children, 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 OFF LIMIT AREAS are all bedrooms, dining room, master bedroom/ master bathroom, hallway bathroom, and kitchen which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, and attached studio located through the double doors in the living room consisting of a bathroom, room, and hallway which leads to 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.

On 7/2/24, a fire clearance was granted to facility #015700396 with no special conditions or comments on the 850. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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.
See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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: 07/11/2024
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As of 7/11/24, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Plumboy. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. An exit interview was conducted, and appeal rights provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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