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Home › HI › Honolulu › Jie & Gordon Zane
License #16300 · Home-based · Family Child Care Home
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Written practices and policies reviewed with staff, volunteers, and/or caregivers upon hire, start of care, or start of residence and on an annual basis <b>Safe sleep training has expired for XXXXX.</b><br/> <br/> Please have them complete the required <b>annual</b> safe sleep training requirement immediately. The certificates shall be uploaded or sent to PATCH so that it can be recorded in the system.<br/>
This annual/biennial licensing inspection recorded no violations or advisories.
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Data synced from Hawaii Executive Office of Early Learning / PATCH on Jul 14, 2026 · Source records · Report an error
DHS 959A Self-Certification of Employment Form and DHS 959 Employment History Clearance Form for your tenants The DHS 959A & 959 employment forms for the last 3 years of employment for XXXXX that we received on July 8, 2024, was incomplete.<br/> <br/> Please have XXXXX enter the two (2) attempted mail dates on the DHS 959 Employment History Clearance Forms that was sent to her past employers.<br/> <br/> DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
DHS 984 Medical Report form to include the physical exam clearance and TB Clearance Please submit a completed DHS 984 Medical Report form which includes a physical examination clearance and TB Clearance for XXXXX that has been completed within a year from the day each tenant moved into your home.<br/> <br/> DHS forms are downable via DHS link at https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
PATCH submission of completed initial and annual Safe Sleep training The Safe Sleep training is an annual requirement for all Family Child Care providers and all their adult household members.<br/> <br/> The annual Safe Sleep training for Keoni Yan has expired and initial Safe Sleep training for XXXXX are required to be completed.<br/> <br/> Also, please submit the Safe Sleep completion certificates to PATCH for:<br/> <br/> 1. XXXXX - Completed - expires 3/27/2025<br/> 2. XXXXX - Waiting for submission<br/> 3. XXXXX - Completed - expires 5/1/2025 (submitted to PATCH SS portal on 6/13)<br/> 4. XXXXX - Waiting for submission<br/>
Please submit altogether the completed DHS 959A Self-Certification of Employment form and DHS 959 Employment History Clearance Form(s) Please complete the DHS 959A Self-Certification of Employment Form and DHS 959 Employment History Clearance Form for your tenants, XXXXX.<br/> <br/> Employment History Instructions:<br/> <br/> Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on form DHS 959A-The date EHC mailed and the date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again in a few weeks and log the 2nd date mailed. If forms are not returned after the second try, we will accept the written self-certification that two mailed attempts were recorded on the DHS 959A.<br/> <br/> DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Please schedule initial fingerprinting appointment with completion of all required background checks Please schedule the initial fingerprinting appointment for your new tenant, XXXXX along with the submitting a completed DHS 948 Authorization for Background Checks to Release Finding form so we can complete all require background checks.<br/> <br/> This deficiency will be satisfied once the initial fingerprinting is complete and all required background checks are the results are satisfactory.<br/>
All employees, household members, and volunteers complete training in safe sleep practices that is approved by the department, upon 30 days of hire or residency, and on an annual basis We received the Safe Sleep Training completion certificates for XXXXX dated 3/18/2024 and XXXXX dated 04/01/2024; however, the Safe Sleep training have expired for XXXXX and XXXXX. Please submit the Safe Sleep completion certificates to PATCH upon completion.<br/>
Employment history check Please complete the DHS 959A Self-Certification of Employment Form and DHS 959 Employment History Clearance Form for your tenant, XXXXX.<br/> <br/> Employment History Instructions:<br/> <br/> XXXXX will need to list her past employers and current employer from July 20, 2020 to the present on the DHS 959A form. A DHS 959 is required to be sent to all the employers that she lists on the DHS 959A. Document the date that the DHS 959 was sent out on the DHS 959A, if there is no response from the employer, a second attempt is required. Please document the date of the second attempt on the DHS 959A as well. We will accept two documented attempts if no response is received from the employers.<br/> <br/> Note: Please include month, day and year specifically for each of employment with the start and end dates.<br/>
Child abuse/neglect check We received the DHS 948 Authorization for Background Checks To Release Findings for XXXXX.<br/> <br/> This deficiency will be corrected upon the completion of all required background checks with satisfactory results.<br/>
Provider and family members have physical exam Please submit a completed DHS 984 Medical Report form that includes the physical clearance date and TB Clearance date for XXXXX that was completed within a year from the day she moved into your home (July 2020).<br/> <br/> DHS forms are downable via DHS link at https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>