376701152-6-20-2019-51-CC-YBAZ-BDBNW3-20190620104854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701152
Report Date: 06/20/2019
Date Signed: 06/20/2019 10:48:58 AM

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:	APPLE YOUCHIEN		FACILITY NUMBER:	376701152
ADMINISTRATOR:	ONO, YUKIKO		FACILITY TYPE:	850
ADDRESS:	2550 FAIRFIELD STREET		TELEPHONE:	(619) 994-0620
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92110
CAPACITY:	30	CENSUS: 7	DATE:	06/20/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Yukiko Ono		TIME COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Yolanda Baez arrived at the facility to conduct an annual random inspection. Upon arrival LPA Baez met with Director, Yukiko Ono. The following ratios were observed:

Room 1 (Serves children of 5 to 12 years of age):

There were not any children or staff members present

Room 2 (Serves children of 2 to 5 years of age):

There were 7 children present with 2 staff members

Appropriate ratios and capacity were observed.

Furniture and age appropriate equipment is in good condition indoors and outdoors. Children's toilets and hand washing facilities are sanitary. Rooms are safe and clean. Lunches are brought from home and the staff members are responsible for serving the lunches. Center provides snacks and menus are posted. Drinking water is readily accessible inside and outside of the classroom through the use of children's water bottles/sippy cups that are brought from home. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children through latches and locks. Storage area for poisons is locked. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, and are in good repair. Outdoor play area is fenced with age appropriate toys. Area has trees used for shade. There are no bodies of water or weapons at this facility. Emergency drills are being conducted every three months, the last emergency drill was conducted on 04/2019. There is an operational smoke detector and carbon monoxide detector at the facility. First Aid/CPR was reviewed and is in compliance. Staff records that were reviewed show verification of education, training, and/or experience and are in compliance. A few children's records were reviewed and are in compliance.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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: APPLE YOUCHIEN	FACILITY NUMBER: 376701152
	VISIT DATE: 06/20/2019

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LPA reviewed the following with Director: IMS, SIDS, Car seat Law, and Shaken Baby Syndrome. This facility does wish to provide Incidental Medical Services- IMS although they currently do not have any child enrolled that requires IMS. Director understands that she must submit an IMS Plan of Operation as soon as possible for review. 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 http://www.ada.gov/childqanda.htm

Immunization law (SB792) was discussed with Director and she understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Facility is compliant with SB792.

LPA Baez discussed the new Mandated Reporter training, AB1207. LPA Baez reminded Director that all staff members are to take the training and have the printed certificates present at the facility and available for review. Facility is compliant with AB1207.

Unusual incident reporting was discussed with Director and reminded Director that corporal punishment is not allowed.

There were not any deficiencies issued throughout today's annual inspection. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed the posting the Notice of Site Visit.

Duty Line: (619) 767-2248, Monday through Friday from 8am to 5pm. To access our Regulation and Forms please use our WEBSITE: http://ccld.ca.gov

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda Baez	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC809 (FAS) - (06/04)

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