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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700396
Report Date: 11/06/2024
Date Signed: 11/06/2024 10:40:10 AM

Document Has Been Signed on 11/06/2024 10:40 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HE, EMILYFACILITY NUMBER:
015700396
ADMINISTRATOR/
DIRECTOR:
HE, EMILYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 519-8328
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
11/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Emily He- LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On 11/6/24, Licensing Program Analyst Briana Plumboy, met with licensee Emily He for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was 2 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, hallway bathroom, and attached studio which can be accessed from the living room and back of the home. Inside the studio is a room, bathroom, and hallway. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are all bedrooms, hallway bathroom, 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 right side of the living room, entire studio consisting of a room, bathroom, and hallway, and the cement area in the backyard. The children in care walk through the hallway in the studio 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, pull down fire alarm, and working telephone. The licensee’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 11/18/2025, and licensee's mother in law's CPR and First Aid certificate is current and expires 12/3/24. The licensee completed and received a certificate in mandated reporter training on 6/1/24, and Xianxiao Ng has a waiver for the mandated reporter training until it is offered in Cantonese. The licensee and her mother in law are in compliance with the 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 fire drill conducted on 10/29/24 and earthquake drill conducted on 9/20/24. 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: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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: 11/06/2024
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Licensee Emily He is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

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.

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.

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.

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: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 11/06/2024
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LPA discussed the safe sleep regulations with licensee Emily He 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 Emily 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.

During the exit interview, the Licensee Emily He 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 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: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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