Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018431
Report Date: 03/09/2018
Date Signed 03/09/2018 09:39:34 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CAO & CHIANG FAMILY CHILD CAREFACILITY NUMBER:
198018431
ADMINISTRATOR:CAO,LING YAN & CHIANG,BOBFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 513-0168
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:14CENSUS: 5DATE:
03/09/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ling Yan Cao and Bob Chiang, LicenseesTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analysts (LPA) Anomeh Eivazian and Stacy Torrence conducted an unannounced required inspection. LPAs met with licensees, Ling Yan Cao and Bob Chiang who guided analysts on a tour of the facility. Also present, was JingJing Li, Licensees’ assistant. There were 5 children present. The purpose of this inspection is to ensure that licensees are in compliance. On 02/06/2018, an office meeting was held with the licensees. During this meeting this facility was placed on 3 years required inspection. At this time, the licensees agreed to ensure the following:

1. Licensees stated that they will ensure compliance with Title 22 Regulations, 102416.5 (a) -Staffing Ratio and Capacity. Per Licensees stated they will only enroll 12 children. Licensees are in compliance and have 12 enrolled at this time.
2. Licensees stated that they will ensure compliance with Title 22 Regulations, 102370(d)(1) - Criminal Record Clearance. Licensees are in compliance.
3. Licensees stated that they will ensure compliance with Title 22 Regulations, 102418 – Immunizations. Licensees are in compliance.
4. Licensees stated they will ensure compliance with Title 22 Regulations, 102417- Operation of a Family Child Care Home. Licensees are in compliance.
5. Licensees stated that they will ensure compliance with Title 22 Regulations, 102369(b)(9) - Application for License. Both licensees were present in the home during this inspection.
6. Licensees stated that they will ensure compliance with Title 22 Regulations, 102416.2(d) - Reporting Requirements. Licensees are in compliance.
7. Licensees stated that they will ensue compliance with Title 22 Regulations, 102359(a)(1) - Advertisements and License Number. The advertisement sign in front of the facility was observed to have the facility number as required.
8. Licensees understand that it is their responsibility to know & understand Title 22 Regulations.
REPORT CONTINUES ON NEXT PAGE 1 OF 5
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
VISIT DATE: 03/09/2018
NARRATIVE
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Incidental Medical Services (IMS): There are no children enrolled that require IMS 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.

LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.



Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Ling Yan Cao and Bob Chiang, Licensees, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
REPORT END 5 of 5
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
VISIT DATE: 03/09/2018
NARRATIVE
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The home was observed to be clean and orderly during this inspection. There is heating and ventilation for safety and comfort. Where children are less than five years old are in care, stairs are fenced or barricaded. There is no stairs in the home. There are toys available for children.

The licensees state that there is a land line on the premises.

The outdoor play area was observed to be fenced. At this time, children are using the back yard (fenced) for outdoor play time.

The licensees were observed to be operating within the license capacity limitations during this inspection.

There was NO ZERO TOLERANCE deficiencies cited during this inspection. Zero Tolerance includes:
Absence of Supervision; Accessible Bodies of Water. No bodies of water on the premises; Accessible Firearms, Ammunition or Both. No firearms or weapons in the home; Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 102370(a ); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles. The facility does not transport children.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensees' Pediatric First Aid and CPR expires on 01/28/2020. There are first aid supplies available.

Per licensees, they carry liability insurance or a bond in accordance with standard established by Family Child Care statue. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file.

Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all of the information specified by regulation
REPORT CONTINUES ON NEXT PAGE 3 of 5
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/23/2018
Section Cited
CCR
102417(g)(9)(A)
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Operation of a Family Child Care Home.
All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.

The licensees conducted last disaster drill on 07/11/17.
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Per licensees, they will conduct the required disaster drills and will complete the required log. The licensees state that they will submit a copy of the disaster drill log by due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
LIC809 (FAS) - (06/04)
Page: 6 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
VISIT DATE: 03/09/2018
NARRATIVE
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9. Licensees stated that they will check the Department's website www.ccld.ca.gov for any updates on a quarterly basis to ensure compliance with California Code Title 22 Regulations.
10. Acknowledgment form for 02/06/18 were observed for all children in care.

The licensees will comply with Health & Safety Codes for Posting Type A licensing reports and maintaining copies of the LIC 9224 in children's files.

Licensees state that there are currently 12 children enrolled, children's roster was available and current.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, day care room (FIREPLACE: there is a fireplace which is inaccessible), backyard (fenced), front yard, and garage (storage). The children use the bathroom in the hallway, main day care room, and back yard (fenced). Per licensees, areas off limits to children and parents include: kitchen, 3 bedrooms, 2 bathrooms, front yard, back of back yard, and garage.

The licensees state that 2 adults and 2 children live in the home. Licensees state that they currently have one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. The following was observed and reviewed during this inspection.

PHYSICAL PLANT: Detergents, cleaning compounds, medications, and other items which could pose a danger were observed to be inaccessible to children during this inspection. The licensees state that there is no poison in the home, but does understand that if any poison is purchased, it is required to be locked with a key or combination lock.

Smoke and carbon monoxide detectors were tested and are operable. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 06/21/17, as indicated on receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.
REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
VISIT DATE: 03/09/2018
NARRATIVE
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H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee does not have proof of immunization against influenza, pertussis, and measles. Licensees and their assistant have proof of immunization on file.

H&S 1596.8662: Commencing January 1, 2018 all the licensed providers, applicants, directors and employees are required to complete training as specified on the mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Licensees completed required mandated reporter training. Certificates on file.

LPAs issued a Confidential Names List (LIC 811) to the licensees which documents the staff and/or children’s files that were reviewed during this inspection.

The following items were also discussed with licensee during this inspection.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 07/11/17.
PETS: There are no pets on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.


Infant Care: Licensees states that she does care for infants. LPAs advised the licensees to sleep infants where they can be directly supervised at all time. LPAs also advised against sleeping infants in a separate. The licensees stated the following as a supervision plan for infants: Licensees state that infants sleep in the day care room.
LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS
REPORT CONTINUES ON NEXT PAGE 4 OF 5
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
LIC809 (FAS) - (06/04)
Page: 4 of 6