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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700464
Report Date: 11/03/2023
Date Signed: 11/03/2023 12:53:33 PM

Document Has Been Signed on 11/03/2023 12:53 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:CHEN, ZHUO WENFACILITY NUMBER:
015700464
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Zhuo Wen "Jennifer" ChenTIME COMPLETED:
01:00 PM
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On Friday, November 03, 2023, at 11 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Pre-Licensing Visit. LPA met with the Applicant Zhuo Wen "Jennifer" Chen. Present on this visit were the Applicant's adult daughter Shuhui "Sophie" Li. The applicant submitted a Family Child Care Home (FCCH) Small License Application and Oakland South Child Care Program Office received the application on04/25/2023.

The home was toured to conduct a Health and Safety Inspection with the Applicant. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort. The home plans to operate from Monday to Friday 8 am to 6 pm.

The On-Limit Areas are the living Room, bathroom adjacent to the front door and the backyard on the first floor. The backyard will be a designated outdoor play area that is fully fenced. The outdoor area has age-appropriate toys that appear to be clean and free from defects and dangerous conditions. There are no pools, hot tubes, or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible. The designated isolation area is the kitchen when a child gets sick in day care.

The Off-Limit Areas are the kitchen, garage, dining room, laundry room, storage room, the side yards on the first floor and the entire second floor. LPA observed safety gates installed on the bottom and top of the stairs, locked cabinets and or with safety latches installed, locked doors on off limit areas and child proof outlet covers.

The home has a fully charged fire extinguisher 3A40BC, smoke detector, carbon monoxide, telephone (cell phone). As per the Licensee, there are no firearms on the premises. The home does have a fireplace and LPA reminded the applicant must be made inaccessible to children in care by safety gates or barricade. LPA observed a pet cat at the backyard.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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: CHEN, ZHUO WEN
FACILITY NUMBER: 015700464
VISIT DATE: 11/03/2023
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The applicant completed the Health and Safety training completed on 3/4/2023, and CPR (Pediatric) and First Aid completed on April 2023 with validity period of 2 years. The applicant completed the AB1207 Child Care Providers training online on 3/28/2023. LPA reminded the applicant that AB1207 requires a 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 the applicant's Secured Property Tax Statement for 2023-2024.

LPA provided technical assistance during inspection with the following.


1. Review of all required forms and information to be kept on file (Children’s forms/Records, Facility forms/Records, Information to be posted) 2. Reporting and Notifications Requirements 3. General Information (Child Care Updates, Provider Information Notification, etc.) 4. Miscellaneous Resources - Resources for Providers https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers and Watch these brief, informative videos to learn more about putting Licensing regulations and requirements into practice - https://ccld.childcarevideos.org/family-child-care-providers/

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.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
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: CHEN, ZHUO WEN
FACILITY NUMBER: 015700464
VISIT DATE: 11/03/2023
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LPA provided the 4Cs of Alameda County, https://4calameda.org/child-care-providers/, 4Cs free Resource and Referral service for families lists licensed family child care homes and Workshops & Trainings. Contact (510) 582-2182 info@4c-alameda.org

​​​​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 FCCH Small license effective today, 11/3/2023.

Exit interview conducted and report was reviewed with the applicant, Zhuo Wen "Jennifer" Chen.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
LIC809 (FAS) - (06/04)
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