Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018431
Report Date: 04/19/2016
Date Signed 04/21/2016 11:06:44 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: 10DATE:
04/19/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ling Cao & Bob ChiangTIME COMPLETED:
11:00 AM
NARRATIVE
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During the course of a case management visit conducted this date, by Complaint Specialist-LPA, Karen Chambers the following was observed and is being cited in accordance with Title 22, California Code of Regulations:

1. The advertisement sign observed in front of the facility, did not have the facility number as required.

2. The smoke detector was observed to be chirping, which is an indicator that the battery needs to be changed

3. The roster that was provided is not current. According to the Licensee, four names are missing.

4. On 4/17/16, the police came to the facility, to discuss an incident that was to have taken place in January (2016) and the Licensee failed to report this.

The notice of site visit was posted where the parents/guardians of children enter and exit the facility. This notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Ling Coa, during which appeal rights were explained. A copy of the appeal rights (LIC9058 12/15) were provided. The Licensee’s signature on this reports acknowledges receipt of her rights.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2016
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, 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: 04/19/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2016
Section Cited
102416.2(d)
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Reporting Requirements. The licensee shall report to the Department as provided by the Health and Safety Code Section 1597.467(b)(1) and (2). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence
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Per Licensee: I will complete and provide a copy
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According to both Licensee's the Police came to the facility to interview them regarding an incident that was to have taken place January, 2016, where a child's personal rights may have been violated while in care. This is a potential risk to the health and safety of children if not corrected.
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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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2016
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, 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: 04/19/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2016
Section Cited
102359(a)(1)
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Advertisements and License Number. Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients. Advertisements subject to Section 102359(a) shall contain specified information. The advertisement sign in front of the facility was observed to not have
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Per Licensee: I will take the old one down. If I put a new one up, I will provide a copy.
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the facility number as required. This is a potential risk to the health and safety of children if not corrected.
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Type B
04/20/2016
Section Cited
102417(g)(1)
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Fire extinguishers and smoke detectors shall meet State Fire Marshal standards. The smoke detector was observed to be chirping during this visit. This is an indicator that the battery needs to be changed. This is a potential risk to the health and safety of children if not corrected.
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Per Licensee: I will change the battery
Type B
04/22/2016
Section Cited
102417(g)(8)
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Operation of a Family Child Care Home. All homes shall have a current roster of the children. The roster that was provided during this visit was incomplete. According to the Licensee there are four names missing. This is a potential risk to the health and safety of children if not corrected.
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Per Licensee: I will update
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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3