573611229-2-9-2023-53-CC-SMAY-CNVW4V-20230209155809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573611229
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:58:21 PM

Document Has Been Signed on 02/09/2023 03:58 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	WONG-XOQUIC, HEATHER AND FELIPE		FACILITY NUMBER:	573611229
ADMINISTRATOR:	WONG HEATHER AND FELIPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 902-8888
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	02/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Heather Wong-Xoquic		TIME COMPLETED:	04:15 PM

NARRATIVE

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On February 9, 2023, Licensing Program Analyst (LPA) Salene Mayberry met with Licensee Heather Wong-Xoquic for the purpose of an unannounced annual random inspection. Also present during the inspection were Co-Licensee Felipe Wong-Xoquic and their adult son. Facility hours of operation are Monday through Friday 8:00 am to 5:00 pm.

A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing. Licensee stated that no new residents have moved into the home since licensure. Capacity specified on the license was met during today’s inspection. Present in the facility were 12 children. LPA verified the annual fees are current.

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.

A health and safety inspection was conducted in all areas accessible to children. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. LPA also observed a current roster and discussed with Licensee the need for fire drills to be conducted at least once every six months. LPA verified the facility maintains a working phone, has a 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPA observed that all hazardous and personal hygiene items are inaccessible to children in care. Licensee stated there are no weapons in the home.

Report continued on LIC809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: WONG-XOQUIC, HEATHER AND FELIPE	FACILITY NUMBER: 573611229
	VISIT DATE: 02/09/2023

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The outdoor play space is fenced and includes a wooden playhouse and two climbing structures, all in good condition. LPA observed age-appropriate toys. There are no bodies of water on the premises. Off-Limit areas are: the kitchen, all the bedrooms, hallway bathroom and the side yard. Licensee acknowledged that children are never allowed in any off-limit areas. Off limit areas will remain inaccessible by closed doors, gates, locks, and supervision.

LPA reviewed 12 children’s files and 3 staff files. LPA confirmed that all required forms were complete and maintained in the files. Current in person EMSA CPR and First Aid certification was verified and expires 04/2023. AB1207 Mandated Reporter Training was also verified and expires 01/2024. LPA discussed the requirement to renew the mandated reporter training every two years and provided the Mandated Reporter training website: www.mandatedreporterca.gov.

Incidental Medical Services (IMS) was discussed. Licensee currently has no children enrolled that require IMS. Licensee understands that when any IMS is provided, a Plan for Providing IMS must be submitted to Licensing.

LPA discussed the safe sleep regulations with Licensee and provided a copy of the LIC9227 Individual Sleeping Plan, for infants under 12 months. LPA also provided 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.

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 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.

Report continued on LIC809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: WONG-XOQUIC, HEATHER AND FELIPE	FACILITY NUMBER: 573611229
	VISIT DATE: 02/09/2023

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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.

Finally, Licensee was encouraged to the visit the Department's website at www.cdss.ca.gov for information regarding childcare updates, forms, regulations and legislation pertaining family childcare homes.

An Exit interview conducted, and the report was reviewed with Licensee. LPA provided Licensee with a copy of the report and posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

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