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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409022
Report Date: 10/15/2021
Date Signed: 10/15/2021 11:56:42 AM

Document Has Been Signed on 10/15/2021 11:56 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:FAN, SHICHAOFACILITY NUMBER:
073409022
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Shichao FanTIME COMPLETED:
12:15 PM
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On 10/15/2021, Licensing Program Analyst (LPA), Diana Campos conducted an in-person case management/increase in capacity inspection. Present during today's inspection were the licensee, her fingerprint cleared parents, licensee's minor daughter and 3 children in care. The entire home was toured to conduct a health and safety inspection with the licensee. Hours of operation for day care are Monday through Friday 8:00am to 6:00pm.

Community Care Licensing (CCL) has received an approved fire clearance.

This is a one story home which consists of a living room, kitchen/dining area, three bedrooms, one bathroom, sun room, attached garage and a back yard patio. The home is neat and clean with heating and ventilation for safety and comfort
On limits: Living room, bathroom, nursery/bedroom to the right of bathroom, and the back yard patio. The kitchen and sun room will only be used as walkway to access the bathroom, nursery room and back yard patio.
Off limits: bedroom at the right end of hallway, bedroom at the left end of hallway, attached garage, and the elevated portion of the back yard.
Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. The patio which is the lower portion of the fenced backyard will be used as the outdoor play area. There are age appropriate toys in the home. The fireplace is blocked to prevent access by children in care. Heating vents are on the ceiling. There are no firearms in the home as stated by the licensee. Per licensee there are no pets in the home. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection.
See 809-C for continuance.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FAN, SHICHAO
FACILITY NUMBER: 073409022
VISIT DATE: 10/15/2021
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The home has a fully charged 2 A 10 BC fire extinguisher. The home is equipped with a working smoke detector and carbon monoxide detector combination unit. There is a working telephone in the home. The applicant’s CPR and First Aid certificate is current and expires 11/2021. Licensee completed mandated reporter training on 10/30/2019. Licensee is in compliance with immunization requirements. Safety precaution in regards to COVID-19 were discussed and posters were posted on front door.

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

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee 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 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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FAN, SHICHAO
FACILITY NUMBER: 073409022
VISIT DATE: 10/15/2021
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No deficiencies observed at this visit. The licensee is now approved for an increase in capacity to operate as a large family day care home.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Shichao Fan.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC809 (FAS) - (06/04)
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