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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416472
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:39:36 PM

Document Has Been Signed on 12/08/2022 02:39 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LU, LIFACILITY NUMBER:
434416472
ADMINISTRATOR:LI LUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 245-8170
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Li LuTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Mel Matos met with Li Lu, Licensee, for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed nine day care children (4 infants & 5 preschool) and one adult assistant (Na An) in the home during today's inspection. Licensee states that the day care serves children ages 12 months to 5 years of age. Licensee was operating within the capacity and ratio requirements of her license. LPA observed the required postings, including the facility license, near the main entrance to the home. Days and hours of operation are Monday - Friday from 8:30 AM to 6:00 PM. The Licensee and her spouse (Xingchang Jiang) are the adults residing in the home. Licensee one minor child, age 10 years old, residing in the home.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on August 18, 2022. Licensee states that she does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all families. Licensee has current CPR and First Aid certifications (expiration: 10/02/2023). Licensee and her adult assistant has the required vaccines (MMR, Tdap, & flu) and are current with her Mandated Reporter Training for Child Care Workers (expiration: 12/13/2022). LPA reviewed five children's files and the files were complete with the required forms and immunization records. LPA reviewed two staff files (Licensee & adult assistant) and the files were complete with the required forms and immunization records.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (650-245-8170). The home is clean, orderly, (including central heating/air conditioning/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no open face heaters or fireplace units inside the home. There are no stairs inside the home. The off limit areas inside the home are: 3 bedrooms & attached one two car garage. The off limit areas outside the home: locked storage shed in the backyard, right side area of the backyard, barricaded air conditioner unit, and right side area of the locked storage shed. Licensee has a play structure in the backyard that is secure and has rubber padding/artificial grass as resilient materials.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee states that she does not have any weapons in the home. Licensee has two caged rabbits that are kept in the off limits area of the backyard. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are stored in the locked storage shed located in the backyard.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
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)
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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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LU, LI
FACILITY NUMBER: 434416472
VISIT DATE: 12/08/2022
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Licensee states that she provides all meals, including snacks (AM & PM) and lunch to the day care children. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee understands that smoking is prohibited in the home.

Licensee states that she does not administer any medications to the day care children 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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands the capacity/ratio options and she understands that she cannot have more than 14 children present in the home without at least two qualified adults present. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that she does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

LPA discussed the safe sleep regulations with the Licensee 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 the 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.

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

Exit interview conducted and report was reviewed with the Licensee, Li Lu. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
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)
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