Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624301
Report Date: 01/22/2016
Date Signed 01/22/2016 03:18:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ZHANG, MIN & STUMMAN, RON FAMILY CHILD CAREFACILITY NUMBER:
376624301
ADMINISTRATOR:MIN ZHANG & STUMMANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 530-8124
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:14CENSUS: 11DATE:
01/22/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Min Zhang, & Ron Stumman, LicenseesTIME COMPLETED:
03:18 PM
NARRATIVE
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(3) Licensing Program Analyst (LPA), Marie Hernandez conducted the inspection. LPA met with the Licensees. LPA was given access to enter and inspect the facility. The Licensee accompanied LPA on the tour of the facility. Present are eleven children with an adult helper during the visit. Incidental Medical Services (IMS) were discussed. Licensee states he wishes not to accept IMS at this time. Licensee is advised if he wishes to accept IMS, she shall submit a written plan within thirty days prior to accepting IMS. Discussed the annual fees. There are no bodies of water and/or weapons in the home. The storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children. The poisons are locked. The fire extinguisher and smoke detector meet State Fire Marshal standards. The facility has a working carbon monoxide detector in the home as required by regulation. The home is kept clean and orderly, with proper ventilation for safety and comfort of children. The Licensee shall be present in the home when children are in care to ensure that they are fully supervised at all times. Licensee will ensure that the children are never left in parked vehicles.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2016
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ZHANG, MIN & STUMMAN, RON FAMILY CHILD CARE
FACILITY NUMBER: 376624301
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2016
Section Cited
102417(A)(1)
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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. Licensee has not maintain the fire/disaster drills. Last drill conducted on 06/15/2015. This poses a potential health and safety risk to children.
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The Licensee shall conduct a fire/disaster drill with the children and shall document the drill by 01/25/2016. The proof shall be submitted to the licensing office by 01/25/2016. Licensee shall conduct the fire drills every six months and shall document the drills per Title 22. The Licensee was provided a copy of the appeal rights (LIC 9058 01/2016) and the signature on this form acknowledges receipt of these rights.
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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: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2016
LIC809 (FAS) - (06/04)
Page: 3 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ZHANG, MIN & STUMMAN, RON FAMILY CHILD CARE
FACILITY NUMBER: 376624301
VISIT DATE: 01/22/2016
NARRATIVE
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When Licensee is temporarily absent from the home, the licensee shall arrange for a substitute cleared adult with a pediatric first aid/CPR certification to care for and supervise the children in licensee’s absence. During today's visit the Licensee has maintained the capacity specified on the license. Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment during the visit. The Licensee has maintained the child roster. Licensee has not maintained the disaster/fire drills. Last drill conducted was on 06/15/2015. The Licensee has maintained the immunization's and the children's records. The Licensee provides the child’s parent or representative with a copy of the family child care home notification of parents’ rights. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed facility. The Licensee has completed the training on preventive health practices. The Licensee's pediatric CPR and First Aid expires on 10/24/2017.

The Licensee shall submit a current copy of the child roster to the licensing agency by January 25, 2016.

The following deficiency has been cited today. An exit interview was conducted and a copy of the report along with the notice of site visit was provided to the Licensee. LPA observed the Licensee post the notice of site visit in a prominent place. The Licensee was provided a copy of the appeal rights (LIC 9058 01/2016) and the signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2016
LIC809 (FAS) - (06/04)
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