198021007-7-7-2022-33-CC-STUG-CG4PPX-20220707113017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021007
Report Date: 07/07/2022
Date Signed: 07/07/2022 11:30:30 AM

Document Has Been Signed on 07/07/2022 11:30 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:	FANG FAMILY CHILD CARE		FACILITY NUMBER:	198021007
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/07/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Jing Fang - Applicant		TIME COMPLETED:	11:45 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	At 8:36AM, Licensing Program Analyst (LPA) Steven Tung conducted a pre-licensing inspection to inspect and evaluate a facility for a Family Child Care Home. A risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Applicant Jing Fang who guided licensing staff on a tour of the facility. Per Applicant, there is one other adult who resides in the home. Operation hours will be Monday to Friday, 8:00AM – 8:00PM. Applicant states that she will care for children 3 months -13 years of age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. Per Applicant, the backyard will be updated to off-limits on the facility sketch. This is a one-story single resident house. The home consists of 4 bedrooms, 3 bathrooms, living room, kitchen, backyard (fenced), front yard(not fenced), garage, and driveway (gated). Per Applicant, the children will use 1 bathroom, 2 bedrooms, and the driveway (gated). Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone/land line), ventilation and heating. Home has central air and heat. LPA observed an open face heater accessible to children in the children’s bathroom. Per Applicant, the open face heater does not work. LPA tested the open face heater by turning it on for 30 minutes and observed the open face heater to be inoperable. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible to children. The applicant states that there are no poisons on the premises. Applicant was advised that any poisons must be locked with a key or combination lock. Page 1

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Tung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FANG FAMILY CHILD CARE	FACILITY NUMBER: 198021007
	VISIT DATE: 07/07/2022

NARRATIVE

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Based on the Facility Sketch submitted, areas off limits to children are: 2 bedrooms in the hallway, the bathroom in the hallway, the bathroom attached to the bedroom next to the backyard, the kitchen, the living room, and the front yard. Per Applicant, the backyard will be updated to be off-limits. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

The children will use the driveway for outdoor play, which was observed to be gated and fenced. Per Applicant, a barrier will be installed on the curb on the right side of the driveway leading up to the garage to prevent children from tripping over the curb. The area that the children are using was observed with no toys. Per applicant, the toys from the backyard will be transferred to the driveway.

The two 2A10BC fire extinguishers in the facility were observed to have service dates of June 30, 2022. Smoke and carbon monoxide detectors were tested and are operable.

There are toys available for children in the indoor spaces. The applicant states that they will only provide snacks for children in care and that the children will bring their own lunches.

The applicant has completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR. There are first aid supplies available.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The following was discussed with the applicant:

- In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Tung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: FANG FAMILY CHILD CARE	FACILITY NUMBER: 198021007
	VISIT DATE: 07/07/2022

NARRATIVE

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- Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
- The fire extinguisher type 2A10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
- Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
- Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
- Fire and safety drills must be performed every six months and documented for review by the Department.
- Smoking is prohibited in a family child care home.
- Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
- No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
- Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
- Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
- Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.
- Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.
- Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Tung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: FANG FAMILY CHILD CARE	FACILITY NUMBER: 198021007
	VISIT DATE: 07/07/2022

NARRATIVE

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Infant Care: Applicant states that they will care for infants. 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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 advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Per applicant, there are no dual licenses at this address. The applicant was advised that email may be public information.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Tung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: FANG FAMILY CHILD CARE	FACILITY NUMBER: 198021007
	VISIT DATE: 07/07/2022

NARRATIVE

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Based on licensing staff observations, the following corrections need to be corrected prior to obtaining a family child care license. Corrections are due 7/14/2022. Applicant will email photos of corrections to LPA by correction due date.
- Applicant will submit updated Facility Sketch with the backyard as off-limits.
- Applicant will submit proof of driveway with toys and the barrier installed on the curb along the right side of the driveway leading up to the garage.

Once corrections are made, the application will be submitted for final review to the department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

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

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.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Tung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

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