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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018983
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:23:38 PM

Document Has Been Signed on 06/17/2021 12:23 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: 10DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Xuefei Bao - LicenseeTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random inspection to the above facility. At 11am, LPA met with licensee, Xuefei Bao. Also present during this inspection, is Licensee’s Assistant noted on the attached LIC811. The licensee states that she currently has 11 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 8am-6pm, Monday-Friday.

This is a one-story home which consists of 4 bedrooms, 2 bathrooms, kitchen, dining room, living room (primarily child play area), front yard and backyard (fenced) with backhouse. The children use the bathroom in the hallway. Per licensee, areas off limits to children and parents include: kitchen, all 4 bedrooms, master bathroom, front yard, and the backhouse. The licensee provides food for children in care. Per licensee 4 adults and 1 minor reside in the home. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT
At 11:05am, LPA was lead on a tour of the facility by the licensee. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. A fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased 04/12/2021, as indicated on receipt provided by Licensee. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Bathroom was observed to be in good repair and functioning properly. At 11:07am, LPA observed detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children.

REPORT CONTINUES PAGE 1 of 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198018983
VISIT DATE: 06/17/2021
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The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. At 11:09am, LPA toured living room that is used as children play space. Napping equipment was placed on ground for children during time of inspection. LPA observed here are first aid supplies available and complete. At 11:10am, Smoke and carbon monoxide detectors were tested and are operable. Fireplaces and open face heaters are inaccessible to prevent access by children. Per licensee, a part of the living room will be used as an area for an ill child until an authorized representative comes to pick up child. The licensee states that a cell phone is used and stays at the facility during operating hours. At 11:14, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard patio for outdoor play time. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2023. Licensee and other personnel have not complete mandated reporter training as Mandarin is their primary language. The licensee and personnel do have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed:

  • Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
  • Licensee has a cat that stays in the off limit area during operation hours
  • Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
  • Smoking is prohibited in a license family child care home.
Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the living room.

REPORT CONTINUES PAGE 2 of 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198018983
VISIT DATE: 06/17/2021
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 LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 observed that a COVID-19 Technical Assistance call had been made on 05/19/2020. LPA observed health and safety practices being conducted at facility.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Xuefei Bao, Licensee, at 12:20pm including, but not limited to Provider Rights, Appeal Procedures, and the Agencies Consultative Role.
END OF REPORT PAGE 3 of 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3