Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018431
Report Date: 06/26/2017
Date Signed 06/26/2017 02:26:41 PM

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: 12DATE:
06/26/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yan Ling Cao and Bob Chiang, LicenseesTIME COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required inspection. LPA met with licensees, Yan Ling Cao and Bob Chiang who guided analyst on a tour of the facility. Also present, was JingJing Li, Licensees assistant. There were 12 children present. The purpose of this inspection is to ensure that licensees are in compliance. On 09/20/16, an office meeting was held with the licensees. At this time, the licensees agreed to ensure the following:

· Licensees will ensure all adults prior to working in their facility obtain a California clearance or a criminal record exemption as required by the Department. Licensees are in compliance.
· Licensees will ensure temporary absences of both licensees not exceed 20 percent of the hours that the facility is providing care per day. Both Licensees were present in the home during this inspection.
· Licensees will ensure to be incompliance with California Title 22 Regulations 102416.2(d) - Reporting Requirements. 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. Licensees are in compliance.
· Licensees will ensure reveal facility license number in all advertisements, publications or announcements with the intent to attract clients. The advertisement sign in front of the facility was observed to have the facility number as required.
· Licensees will ensure that areas covered under 102417 - Operation of a Family Child Care Home are in compliance at all times. Fire extinguishers was fully charged but has not been serviced annually as it is required. It was purchased on 07/2015.
· Licensees will ensure that areas covered under 102417 - Operation of a Family Child Care Home are in compliance at all times. Facility children roster was current and available for review.
REPORT CONTINUES ON THE NEXT PAGE 1 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2017
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CAO & CHIANG FAMILY CHILD CARE
FACILITY NUMBER: 198018431
VISIT DATE: 06/26/2017
NARRATIVE
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INFANT CARE: Licensees state that they do care for infants. LPA discussed plan for supervising infants.
Licensees state the following: Licensees state that infants sleep in the day care room. LPA advised the licensees to sleep infants where the infant can be directly supervised. LPA advised against sleeping infants in a separate room. If the licensees choose to sleep infants in another room, the licensees are advised to conduct periodic checks to the room and a baby monitor is advised to also be used. LPA provided the following documents about SIDS.
1) SIDS and Kids flyer from www.sidsandkidsshop.org
2) Helping you to reduce the risk of SIDS

Medication: 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 advised the licensees how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. LPA discussed and provided the licensees with a packet with updated forms during this visit. Forms provided are as follows: 1) Forms/Records to Keep in your Family Child Care Home (LIC311D), 2) Updated Parents’ Rights Poster w/Complaint Hotline Information (PUB394), 3) Children’s Roster (LIC 9040), 4) Sample Disaster Drill Log, 5) Never Shake a Baby (PUB271), 6) Capacity Handout (Small & Large). 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 this information, the following deficiencies listed on the attached LIC 809D 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 by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Yan Ling Cao and Bob Chiang, Licensees, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
REPORT END 4 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2017
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2017
Section Cited
102417(g)(1)
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Operation of a Family Child Care Home.
Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.

Fire extinguisher not serviced annually as required. Receipts provided shows that the fire extinguisher was purchased 07/2015.
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Per licensees, they will purchase a new fire extinguisher and will submit copy of receipt as proof of correction.
Type B
07/14/2017
Section Cited
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.

Disaster drill log not available.
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Per licensees, they will complete the disaster drill log and will submit a copy as proof of correction by due date.
Type B
07/14/2017
Section Cited
H&S 1597.622(c)
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Employee and Volunteer Immunization.
The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
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Per Licensees, required Proof of Immunization (Pertussis, Measles, and Influenza) will be obtained by plan of correction due date, and a copy will be provided to the licensing department by plan of correction due date as proof of correction.
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During this inspection Licensees and their assistant did not have Proof of Immunization (Influenza, Pertussis, and Measles) on file.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2017
LIC809 (FAS) - (06/04)
Page: 4 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: 06/26/2017
NARRATIVE
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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, and garage. The licensees provide food for children in care. The licensees state that 2 adults and 2 children live in the home. Licensees state that she currently have one assistant.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger were observed to be inaccessible to children during this inspection. Cleaning compounds and medication are inaccessible to children. Poison is locked in garage. Fireplaces and open face heaters are inaccessible to prevent access by children. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 07/2015, as indicated on service tag, bur has not been serviced annually as it is required. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable.


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 are no stairs in the home. There are toys available for children.

The licensees understand that in their absence a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license. The licensees were observed to be operating within the license capacity limitations during this inspection.
REPORT CONTINUES ON THE NEXT PAGE 2 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2017
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2017
Section Cited
102418(g)
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Immunization.
Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.
During this inspection immunizations record was not available for child #2, #4, and #5.
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Per licensees, they will obtain copies of immunization records for child #2, #4, and #5 and will submit a copy by due date as proof of correction.
Type B
07/14/2017
Section Cited
102369(b)(9)
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Application for License. Licensees and any adult in the home, shall provide evidence of a current tuberculosis clearance, performed and signed by a physician not more than one year prior to or seven days after first day of employment.
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Per Licensees, Jing Jing Li will obtained required TB Test and a copy will be submitted by plan of correction due date.
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During this inspection licensees' assistant, JingJing li (LISA) does not have TB test clearance on file. Per licensees, she has been working in this facility since June 2016.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2017
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: 06/26/2017
NARRATIVE
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All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Disaster drill log was not available during this inspection. The licensees and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensees' Pediatric First Aid and CPR expire on 02/07/18. There are first aid supplies available.

Children’s records were reviewed, including but not limited to, Immunization Records and Notification of Parents’ Rights receipt for children present. LPA issued the Confidential Names List (LIC 811) to the licensees during this inspection. The Confidential Names List (LIC 811) documents the staff and/or children’s files that were reviewed during this inspection. Proof of immunization (Pertussis, Measles, and Influenza) was not available for licensees and their assistant.

There was NO ZERO TOLERANCE deficiencies cited during this visit. 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 101238 (g)(2); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles. The facility does not transport children.

The following items were also discussed with licensee during this visit.
PETS: No pets on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

REPORT CONTINUES ON THE NEXT PAGE 3 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2017
LIC809 (FAS) - (06/04)
Page: 3 of 6