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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004524
Report Date: 12/21/2021
Date Signed: 12/21/2021 03:17:48 PM

Document Has Been Signed on 12/21/2021 03:17 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ZHOU, MIAO YINFACILITY NUMBER:
384004524
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Miao Yin ZhouTIME COMPLETED:
11:08 AM
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On December 21, 2021 at 9:30 A.M., Licensing Program Analyst (LPA), Sheran Lo met with applicant Miao Yin Zhou for a schedule prelicensing inspection at the facility. Inspection included a technical assistance review for COVID-19 prevention and mitigation measures. Present is the applicant. Applicant rents the apartment, which is a two bedroom, two bathroom unit. Living in the home in applicant. Criminal record clearances are on file. Days and hours of operation are Monday - Friday, 8:00 AM. to 6:00 PM. Daycare Area: Living Room (Playroom), Napping Room (Bedroom #1), and Bathroom #1. Off-limit Area: Bedroom #2, Bathroom #2, and Kitchen. LPA inspected home with applicant for health and safety hazards.

At 10:00 A.M., The following was observed: Day-care area was clean and orderly with a variety of age appropriate wooden toys, books and padded play area for the children. Furniture and playthings inspected are new and in good condition. Napping room, located next to the playroom, had two cribs and mats for resting. Cubbies shelf is located by entrance for storage of children’s belongings. Infant changing table is located in the Bathroom #1. Playroom had one child size table and several chairs for meals and activities. Per applicant, children will be served meals in the playroom for age 12 months and up which has adequate supplies. Playroom and napping room have a window for ventilation and lighting which the opening is inaccessible to children. LPA observed all accessible electrical outlets, trash bins had been properly covered. Detergents and cleaning supplies were made inaccessible, stored under the bathroom sink. Facility has functioning cell phone, smoke/ carbon monoxide detector combo and fire extinguishers (2A:10:BC). Per applicant, she has no pets or body of water. Per applicant, there are no guns or weapons in the home. Playroom was free of hazards or dangerous conditions. Isolation area for an ill child will be in the Napping Room. Accessible cabinets and drawers and bathroom #1 had child safety locks installed. Bathroom #1 was in operating condition.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ZHOU, MIAO YIN
FACILITY NUMBER: 384004524
VISIT DATE: 12/21/2021
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Applicant was informed that the Department must be notified that prior to use of any off-limits areas. Licensing forms and posting requirements were reviewed with the applicant. LPA discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Applicant stated she plans to provide food for the children. LPA reminded applicant that food brought from home should be properly labeled. Applicant understands that fire/earthquake drills are to be conducted every six months and recorded. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family childcare homes. Applicant's CPR/1st Aid certification was current, expiring: 11/2023. Mandated Reporter Training was current, expiring: 3/2022. Applicant was informed that all adults 18 -years and older, living in the unit or assisting with children, must have their criminal record clearance and be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID, prior to having any contact with day-care children. Failure to do so could result in an immediate civil penalty of $100.00 each day. Applicant was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized for pertussis, measles, and influenza or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

Applicant was reminded about the Mandated Reporter training available on CCLD website. Training must be completed every 2 years by the applicant and all staff hired. Training can be taken online: www.mandaterreporterca.com.



Applicant was informed about the Provider Information Notices (PINs) on CCLD website. Safe Sleep handout and PINs were discussed. (REFER TO 809-C FOR CONT.) Applicant can also email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Prior to recommended for licensure, after the following:


Review by Department management

Copy of this report will be email to applicant. Desk Duty is available Monday through Friday between 8 AM - 5 PM at (650) 266-8800
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
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