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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409022
Report Date: 04/06/2022
Date Signed: 04/06/2022 01:34:32 PM

Document Has Been Signed on 04/06/2022 01:34 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:FAN, SHICHAOFACILITY NUMBER:
073409022
ADMINISTRATOR:FAN, SHICHAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 608-0048
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Shichao FanTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Diana Campos arrived at the facility for an unannounced annual required inspection and met with the licensee Shichao Fan. Present for this inspection was the licensee's spouse, assistant, and 6 children in care consisting of 2 infants and 4 preschoolers. Licensee was in compliance with the licensed capacity and facility ratios. Phone number is current. The day care area of the home was inspected with the licensee.
This is a one story home. Off-limit areas remain as previously licensed and kept inaccessible to children by closed and/or locked doors and visual supervision. All required forms were posted. There was a working combination smoke and carbon monoxide detector (tested); a fully charged 2 A 10 BC fire extinguisher; a first aid kit.

The home was clean and orderly, with heating and ventilation for safety and comfort. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. There is a fireplace which is blocked to prevent access by children. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept on top of a high cabinet, or inside child proof latched cabinets inaccessible to children. Licensee stated there were no firearms or pets in the home. There are no bodies of water on the premises.

Back yard area is securely fenced. Licensee has riding toys, balls, and other toys in the backyard for child play that appear to be safe and in good condition during today's inspection. A sample of files were reviewed and found to be complete. Facility roster is available for review and a copy was obtained. Licensee's CPR/First Aid certificate is current and expires 10/23/2023. Licensee has completed mandated reporter training on 10/2021.
SEE 809-C FOR CONTINUANCE-------------------------------------------------------------------------
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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: 04/06/2022
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Licensee is not currently providing any IMS services to children in care. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

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.

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: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
LIC809 (FAS) - (06/04)
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