Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413322
Report Date: 05/17/2017
Date Signed 05/17/2017 02:53:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:JIA, RONGMEIFACILITY NUMBER:
434413322
ADMINISTRATOR:JIA, RONGMEIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 858-3510
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:14CENSUS: 12DATE:
05/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Rongmei JiaTIME COMPLETED:
03:15 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
LPA Oscar Huang met with licensee Rongmei for an annual/random visit. LPA explained the nature of today’s visit to licensee. LPA also observed one adult assistant and 12 day care children (3 infants & 9 preschool) in the home during today's visit. Days and hours of operation are Monday to Friday, 8:30am to 6:30pm. The adults that reside in the home are licensee and her husband.

A review of staff records on 05/17/2017 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Licensee understands upon notice of the Department to remove an individual from the home, or to exclude an individual from the home, the licensee shall immediately remove the individual and prevent them from returning to the home or having contact with children in care.

LPA toured the indoor and outdoor areas of the home during today’s visit. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed no stairs inside the home. The main area of the home is used for the day care are living room, dinning room, a bedroom and a bathroom. LPA observed a barricaded fireplace. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher, a working smoke detector, and a functioning carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: a master bedroom, a bedroom, kitchen and the garage. LPA observed a fenced backyard and no bodies of water. LPA observed a locked storage shed in the fenced off area. Off limit areas outside the home: both side yards and the backyard where the storage shed is. Licensee owns the house, and carry child care liability insurance with DCI.

LPA observed licensee has current CPR and First Aid certification expiring 04/2019. LPA observed a current roster of the children and a fire and disaster drills log which is to be done at least once every six months. The last drills were conducted on 01/03/2017. LPA reviewed 12 children files. Immunization records are maintained and up-to-date, and updated in form PM 286. LPA observed Notification of Parents’ Rights is in each child’s file.
Facility Evaluation Report dated 05/17/2017 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2017
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: JIA, RONGMEI
FACILITY NUMBER: 434413322
VISIT DATE: 05/17/2017
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
Facility Evaluation Report dated 05/17/2017 to be continued from previous page:

Supervision of children was discussed with licensee, and understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options. LPA provided licensee with the ratio/capacity chart for her reference. Licensee states that she does not transport children via vehicle but she understands that children cannot be left in parked vehicles unattended at any time.

LPA discussed Zero Tolerance with $150 civil penalty. LPA discussed the requirements of AB633 to licensee and licensee understands the requirements. LPA discussed SB 792 Immunization Requirement with licensee. LPA observed appropriate records for immunization against measles, pertussis, and influenza for licensee and her helper in file.

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. Licensee stated that she does not administer IMS currently.

No Deficiency was cited.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2