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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020189
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:44:19 AM

Document Has Been Signed on 12/08/2022 11:44 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HUANG FAMILY CHILD CAREFACILITY NUMBER:
198020189
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Licensee, Xiao Ji HuangTIME COMPLETED:
11:50 AM
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
An announced annual inspection was conducted by Licensing Program Analyst (LPA) Bardo Baluyot. LPA is also addressing Licensee's request to increase capacity to a Large Family Child Care Home. Upon arrival, LPA conducted a COVID risk self-assessment and met with licensee who guided LPA on a facility tour. Licensee and 1 child were observed to be wearing masks during entire visit. Licensee is Cantonese speaking. Licensee's spouse and 1 adult son were also present during this visit. Licensee's son was able to assist with translation when needed. Licensee also has another minor aged child that lives in the home. LPA observed 4 children in care of which 3 were infants.

Areas accessible to children were inspected as follows: Living room, hall bathroom and fenced front/side yard (cement area) for outdoor play.

Per licensee, there are no weapons, firearms, swimming pool/spa on the premises. There are age appropriate toys and equipment on the premises. The smoke/carbon monoxide detectors and fire extinguisher (2A 10BC) are in operable condition. Service tag on fire extinguisher is current and was last serviced on 2/18/2022.

Areas off limits include: 2 bedrooms, fenced backyard, kitchen and garage. Per Licensee, there are currently 7 children enrolled.

-Licensee has completed the 16 hour health & safety and her Pediatric First Aid/CPR Certificate will expire 11/28/2023.

-Child Care Roster, Disaster Plan, Children records and required licensing forms were reviewed and found to be complete.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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: HUANG FAMILY CHILD CARE
FACILITY NUMBER: 198020189
VISIT DATE: 12/08/2022
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
26
27
28
29
30
31
32
Rooms that are off-limits are made inaccessible during operating hours. LPA observed 2 safety gates to make all entries into the kitchen inaccessible to children. Per Licensee, there is no smoking in the home. No infant walkers, Johnny jumpers, exersaucers, bouncers and any other item that falls into that category were observed. Crib and sleep mats were observed. All required postings were observed. Fire Inspection was completed on 11/30/2022 and Fire Clearance is on file. Licensee was previously informed via email to complete the Mandated Reporter Training on department website at http://www.mandatedreporterca.com/ once training becomes available in her language.

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. Per Licensee, there are currently (0) children with IMS.

LPA discussed the safe sleep regulations with licensee (via Licensee's son) and discussed the Child Care Licensing Safe Sleep web page 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.

At this time, Licensee's home meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of the California Code of Regulations and request will be submitted to LPM for final approval to be licensed as a Large Family Child Care Home.



Exit interview conducted and report was reviewed with the licensee

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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: HUANG FAMILY CHILD CARE
FACILITY NUMBER: 198020189
VISIT DATE: 12/08/2022
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
26
27
28
29
30
31
32
 http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
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

3 of 3

END OF REPORT

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3