376100450-7-28-2020-51-CC-SSIO-BRXVFU-20200728162431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100450
Report Date: 07/28/2020
Date Signed: 07/28/2020 04:30:30 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:	LU, KRISTINA FAMILY CHILD CARE		FACILITY NUMBER:	376100450
ADMINISTRATOR:	KRISTINA LU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 349-6580
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92129
CAPACITY:	14	CENSUS: 2	DATE:	07/28/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kristina Lu		TIME COMPLETED:	11:30 AM

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	At 10:00 am on 07/28/2020, Licensing Program Analyst (LPA), Selina Siao conducted a change of location pre licensing tele inspection via Face Time with applicant due to COVID-19. The 4 bedroom, 3 bath, 2 story home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 2A10BC, smoke and carbon detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Applicant stated that the home doesn't have any bodies of water or weapon. Applicant has an EMSA approved pediatric CPR and First Aid card that are current due to expire on April 2021 and applicant completed the mandated child abuse training on 10/14/2019. Applicant is in the process of completing the 8 hours preventative health practice course that includes the lead poisoning prevention. A review of the application and records on this date, it indicates that applicant and her husband Raymond Lu are the current adult residents at the home with the require TB clearances, caregiver background checks and child abuse clearances. Applicant has the required immunizations. Applicant and her husband own the property and has provided a copy of the grant deed to show that they have control of the property. Applicant will be using the following areas for childcare: living room, kitchen, playroom and bathroom located downstairs. Upstairs childcare areas if approved by the fire department will include the loft area, bathroom, bedroom 2 and bedroom 3. Off limit areas includes the garage and upstairs off limit areas includes the laundry room and master bedroom/bath. All off limit areas has a lock, safety gate or latch to prevent day care children's access. There is a safety gate at the bottom and top of the stairs to ensure children's safety.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LU, KRISTINA FAMILY CHILD CARE	FACILITY NUMBER: 376100450
	VISIT DATE: 07/28/2020

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

Outdoor area will be the fenced backyard and visual supervision is required when children are outside.
Applicant was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties of $100 per day, car seat law, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty crib on a firm mattress.

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

Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at www.ccld.ca.gov . LPA discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

Applicant has completed and submitted the family childcare self-certificate checklist.

A large license will be granted pending fire clearance. Upstairs of the home has fire sprinklers and applicant is awaiting to obtain approval from the fire department. Applicant understands that upstairs can only be use with written approval from the fire department.

Analyst read the report to applicant during the tele-inspection. A copy of the report will be e-mailed to applicant and she was advised that acknowledgement of the receipt of the report is to be received from applicant within twenty-four hours.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2