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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409063
Report Date: 07/16/2021
Date Signed: 07/16/2021 11:37:26 AM

Document Has Been Signed on 07/16/2021 11:37 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:HU, GRACEFACILITY NUMBER:
073409063
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Grace HuTIME COMPLETED:
12:00 PM
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On 7/16/21 at 9:15 AM Licensing Program Analyst (LPA) Michelle Sutton conducted an announced CHANGE OF CAPACITY Inspection at Grace Hu home and met with Licensee, Grace has applied for a Large Family Child Care Home with a capacity of 14 children. Residing in the home is the Licensee, her finger print cleared husband and 3 children (ages 6, 4, 2). The home was toured to conduct a Health and Safety Inspection. The Child Care home operates Monday-Friday from 9am-5pm. Present during today's inspection was 6 children ages 2-6 and assistant Gloria Ferezi.

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. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

The home is two story. The home consists of 3 bedrooms, 3 bathrooms, living room, dining area, kitchen, basement, backyard, and garage. The home is neat and clean with heating and ventilation for safety and comfort.
The OFF LIMIT AREAS: The entire upstairs, kitchen, basement, and garage which will be inaccessible by closed and/or locked doors, safety gates and visual supervision.
The ON LIMIT AREAS: At 9:45 AM LPA toured the living room, dining area (play rooms), bathroom in the hallway to the right of the entry way, and backyard. The fire place is fenced and covered with a shelf inaccessible to children. The ISOLATION AREA will be in the entry way with a seating area. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
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: HU, GRACE
FACILITY NUMBER: 073409063
VISIT DATE: 07/16/2021
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OUTDOOR SPACE: At 10:00 AM LPA toured the backyard which is completely fenced with 100% supervision. The kitchen will only be used as a walkway to the backyard with 100% adult supervision at all times. The outdoor play area is free from defects or dangerous conditions. The backyard is split into two areas: a small area outside of the kitchen and the other area that is bigger through another fence gate. There is an ample supply of toys and activities available for children outside, and they are in good condition and age appropriate. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

LPA observed: fully charged 2A10BC fire extinguisher near front door, working smoke and carbon monoxide detector next to stairs. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare home. Licensee states that there is a pet getko and no arms and ammunition stored in the home.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA discussed the responsibility as a mandated reporter and has provided proof of the required mandated reporter training for child care providers, which expires 2/2022.

On 06/14/21, a fire clearance was granted to facility Grace Hu by ECC Fire Protection Department. All documents have been reviewed 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.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.



There are no deficiencies cited today. The report will remain on file for three years. Notice of Site was given. At 11:30 AM Exit interview was conducted with Licensee and she signed the report acknowledging receipts of documents. Licensee Large Family Child Care Home license is effected 7/16/21.
END OF REPORT
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC809 (FAS) - (06/04)
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