434412281-4-13-2023-52-CC-CURE-CQURQU-20230413131408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412281
Report Date: 04/13/2023
Date Signed: 04/13/2023 01:15:03 PM

Document Has Been Signed on 04/13/2023 01:15 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ZHENG, VERA & XU, BAIRONG		FACILITY NUMBER:	434412281
ADMINISTRATOR:	ZHENG, VERA & XU, BAIRONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 823-3396
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94043
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 10	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Vera "Eva" Zheng		TIME COMPLETED:	01:30 PM

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On 04/13/2023 at 10:00am Licensing Program Analyst (LPA) Christina Uribe, met with licensee Vera "Eva" Zheng for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 10 daycare children and 1 fingerprint cleared assistant & resident of home, Bairong "Vivi" Xu, and the licensee is within ratio today. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 8:00am-6:00pm.

The home is a single story home with 3 bedrooms, 1 bathroom, living room, kitchen, garage and back yard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort.

The OFF-LIMIT AREAS are bedroom #2 & #3, kitchen, & garage and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS is the additional bedroom, bathroom, living room, and backyard that are used as the main day care areas. The backyard is fully fenced and is in good condition and free from hazardous materials. There is a large shed on the side yard that is inaccessible to children in care.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone and fully stocked first aid kit. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. Per licensee, there are no firearms on the premises or pets in the home.

The licensee completed the Health and Safety training, CPR/First Aid certification expires on 01/08/24. The licensee is in compliance with the immunization laws and has completed the mandated reporter training on 04/01/22.

The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 03/23/23. All required forms are posted and visible for public review.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHENG, VERA & XU, BAIRONG	FACILITY NUMBER: 434412281
	VISIT DATE: 04/13/2023

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LPA Uribe reviewed 10 children’s files and personnel records. Licensee does not care for children under the age of 2 and safe sleep regulations are not needed. There is a current roster available for review. The facility does have liability insurance which is valid. Staff interview also conducted and documented.

Incidental Medical Services (IMS) policy was discussed and the facility does not have any children with the need for medication to be kept at the facility at this time. 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.

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 communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ZHENG, VERA & XU, BAIRONG	FACILITY NUMBER: 434412281
	VISIT DATE: 04/13/2023

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No deficiencies found during today's inspection. Please see attached advisory note pages and list below for technical violations issued today:

Technical Violation: Facility Roster needs to be updated and complete with children and parent's first and last names.
Technical Violation: Some children's Identification & Emergency (LIC 700) form needs the section for additional persons to be called in an emergency to be filled out by parents. One child's LIC 700 form also needs the parents signature & date at the bottom of the form.
Technical Violation: Some children's files are missing a printed copy of their immunization record from their physician's office.
Technical Violation: Child locks on bathroom cabinet doors need to be adjusted and fastened tightly to prevent children access to the cabinets below sink.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Vera "Eva" Zheng.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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