<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018983
Report Date: 04/02/2021
Date Signed: 04/02/2021 06:16:07 PM

Document Has Been Signed on 04/02/2021 06:16 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BAO FAMILY CHILD CAREFACILITY NUMBER:
198018983
ADMINISTRATOR:XUEFEI BAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 456-1322
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
04/02/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Xuefei Bao - LicenseeTIME COMPLETED:
06:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Nolan Tcheng and Emiko Bell conducted an unannounced in-person Case management-Deficiencies inspection to cite for deficiencies found during an inspection. Upon arrival, LPAs met with Licensee Xuefei Bao, to whom the purpose of the inspection was explained. At 2:10PM, LPAs were given a tour of Children Room where there were eight children napping. Census was taken. There were 2 infants present and 6 children ages 2-6 present at the time of inspection. Also present during the inspection was Licensee’s spouse and a minor but in a separate part of the house.

Licensee stated her assistant left at 1:45PM. Assistant later returned at 4:10PM. During the time of inspection Licensee was alone with two infants, five children ages 2-5, and one child age 6. Facility can have more than six and up to eight children, without an additional adult attendant when at least one child is enrolled in kindergarten or elementary school and a second child is at least six year old. Therefore Licensee was out of ratio by not having an additional school age child present during the time that the assistant was not at the facility. Please see 809-D for documentation of deficiency.

Upon receipt, the Licensee shall post the “D” page of the Licensing report and the Notice of SIte Visit. These pages shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

An exit interview was conducted with Licensee Xuefei Bao, at 6:30PM. A copy of this report was signed and appeal rights were provided to licensee.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 04/02/2021 06:16 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 04/02/2021 at 05:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BAO FAMILY CHILD CARE
FACILITY NUMBER: 198018983

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2021
Section Cited
CCR
102416.5(b)(3)(a)

1
2
3
4
5
6
7
Staffing Ratio and Capacity
A small family day care home may provide care for more than six and up to eight children, without an additional adult attendant...At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
1
2
3
4
5
6
7
Per Licensee if assistant is not present, licensee's spouse can step in to assist with the care of the children. Written Declaration was obtained during inspection.
8
9
10
11
12
13
14
This requirement as evidenced by licensee being alone with 8 children, only one of whom was age six. This took place from 1:45pm to 4:10pm. THis poses an immediate health, safety, or personal rights risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2