<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004853
Report Date: 11/05/2021
Date Signed: 11/05/2021 11:39:07 AM

Document Has Been Signed on 11/05/2021 11:39 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:YANG, QIAOLINGFACILITY NUMBER:
414004853
ADMINISTRATOR:YANG, QIAOLINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 489-5707
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/05/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Qiaoling YangTIME COMPLETED:
12:00 PM
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
On November 5, 2021 at 10:00 AM, Licensing Program Analyst (LPA) Cowan conducted an announced Pre-Licensing inspection. The applicant is applying for a small family childcare license. Applicant lives in a four-bedroom and three-bathroom home with boyfriend and minor child. The applicant states that this is her primary residence where she live full time. Applicant is present alone in the home this day.

Childcare areas are bedrooms 1 and bathroom 1. The off-limit areas: kitchen, living room, bedrooms 2, 3, and 4, bathroom 2 and 3, and all storage areas. The day-care will operate 8:00 AM to 6:00 PM, Monday through Friday.

Applicant states that they understand that they are the primary person responsible for operating and providing care and supervision to the children, regardless if the applicant hires helpers to work with them. Applicant states they understands that they may only be absent from the home no more than twenty percent of the operating hours. During the twenty percent absence, applicant understands that they may designate another person to provide care and supervision to the children who is qualified with Mandated Reporter Training, Pediatric CPR and First Aid Training, has obtained criminal record clearances, child abuse index checks, TB clearance, immunizations as required by law, and has a signed Criminal Record Statement and Acknowledgement to Report Suspected Child Abuse forms.

Report Continues on Page 2
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: YANG, QIAOLING
FACILITY NUMBER: 414004853
VISIT DATE: 11/05/2021
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
26
27
28
29
30
31
32
Page 2
Capacity and ratio options were reviewed with the applicant today. Applicant states they understands that care cannot be provided for more than the capacity as stated on the license. LPA caring for the two additional children (6 years plus in age and one of the two children can count if they are enrolled in Kindergarten) and must also notify the parents if care is being provided to the two additional children. Applicant will require parent’s sign the affidavit for liability insurance or obtain adequate liability insurance.

During today’s inspection, LPA toured the home and yard. LPA observed the following today: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. There are no bodies of water on the property. There is no fireplace in the day-care area. There are no detergents, or cleaning products accessible to day-care children. Applicant does have firearms on the premises which are properly stored.

LPA discussed care and supervision, transportation of children, visitors to the home, reporting suspected child abuse, reporting requirements for unusual incidences, isolation of sick children, and discipline. Discipline used will be redirection. Safe sleep regulations were discussed and a copy is given to applicant along with FAQs.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: YANG, QIAOLING
FACILITY NUMBER: 414004853
VISIT DATE: 11/05/2021
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
26
27
28
29
30
31
32
Page 3
LPA discussed the required day-care forms with the applicant. Records for Children and helper files were discussed. Required Postings were discussed. Applicant states that they understand that emergency drills must be conducted at least once every six months and be properly logged. Children’s roster was reviewed.

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

Applicant is not planning to provide IMS and agrees to submit this plan to the Regional Office.

Applicant was informed about the Provider Information Notices (PINs) on CCLD website.
Applicant was reminded about Mandated Reporter Training available on CCLD website. Training is valid for two years.
(www.ccld.ca.gov or www.mandatedreporterca.com)
Applicant was advised of ‘Safe Sleep” and provided with handouts regarding “safe to sleep “ best practices.

The following corrections will be necessary before a license to operate a small family child care license can be recommended:
· All Licensing Postings must be properly posted
· Fingerprint Clearance for adults in home
· Receipt of all required licensing documents (FLU vaccine)
· Inspection of rear storage area

This report and appeal were discussed with Applicant. For additional questions please call: San Bruno Child Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or the Centralized Complaint and Information Bureau at 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3