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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700253
Report Date: 03/03/2023
Date Signed: 03/03/2023 09:56:14 AM

Document Has Been Signed on 03/03/2023 09:56 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:TANG, JINGFACILITY NUMBER:
075700253
ADMINISTRATOR:TANG, JINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(814) 777-6826
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Jing TangTIME COMPLETED:
09:53 AM
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On 3/3/2023 at 8:15am Licensing Program Analyst (LPA) Morgan Pringle met with Applicant Jing Tang for an Announced Pre-Licensing Visit for a Large Family Child Care Home. Present during the inspection was the Applicant, her husband, Xiaokun Ma and their two (2) minor children. Applicant lives in the home with her husband, their six (6) year old daughter and three (3) year old son. The Applicant’s home was toured for a health and safety inspection. The facility plans to operate 8:00am – 6:00pm, Monday – Friday.

ON LIMITS AREA: Living Room, Family Room, Downstairs Bathroom and Backyard


OFF LIMITS AREA: Entire 2nd Floor, Laundry Room, Kitchen and Garage
ISOLATION AREA: Living Room

The facility is a two-story home owned by the Applicant. The home consists of a kitchen, living room, family room, two (2) full bathrooms, one (1) half bathroom, four (4) bedrooms, laundry room, garage and backyard.

The home was granted a fire clearance on 2/15/2023 from the San Ramon Valley Fire Protection Department with the condition of childcare no provided on the second floor and the garage and the use of the security chain on the front door is prohibited from use during business hours.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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: TANG, JING
FACILITY NUMBER: 075700253
VISIT DATE: 03/03/2023
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The inside of the home is observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. All off limit areas in the home will be blocked off with closed doors and gates. The stairs in the family room is gated making the second floor inaccessible to the children in care. The electric fireplace in the family room is locked making it no hazard to the children in care. Applicant has stated there is one (1) firearm in the home. The firearm is properly stored in the home and kept in an off-limits area. Applicant also stated there are no pets in the home. The home has centralized heat and air for proper ventilation. LPA did not observe any harmful bodies of water in or around the home.

The backyard is clean, free from hazards and fully fenced. There will be ample age appropriate materials for the children that are clean, well maintained and with no defects.

There is a 3A40BC fire extinguisher in the downstairs hallway as well as at the top of the stairs. There is a working smoke/carbon monoxide detector in the family room and the upstairs hallway. There are working smoke detectors in all four (4) bedrooms. The Applicant’s Health and Safety training with the lead poisoning component has been completed and Pediatric CPR and First Aid certificates are current and expires on 10/9/2023. Mandated Reporter training are complete and expires on 8/15/2024. All adults living the home have obtained a criminal record clearance. Applicant has provided immunization's for influenza, measles, pertussis and has a current record of tuberculous.

Applicant were reminded that California Law requires 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 email. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov. Applicant were also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

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

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: TANG, JING
FACILITY NUMBER: 075700253
VISIT DATE: 03/03/2023
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Applicant were reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Applicant were reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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.

Applicant were 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 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 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: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

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

DATE: 03/03/2023
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: TANG, JING
FACILITY NUMBER: 075700253
VISIT DATE: 03/03/2023
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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 reviewed with Applicant the LIC311D, Forms/Records To Keep In Your Family Child Care Home, Children’s Forms/Records, Facility Forms/Records, and Information to be Posted.

Entrance checklist was provided to the Applicant.

Exit interview conducted and report was reviewed with the Applicant Jing Tang.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

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

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4