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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504635
Report Date: 03/08/2022
Date Signed: 03/08/2022 12:16:43 PM


Document Has Been Signed on 03/08/2022 12:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KWONG, KAM MINGFACILITY NUMBER:
380504635
ADMINISTRATOR:KWONG, KAM MINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 387-7187
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:12CENSUS: 4DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kam Ming KwongTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Kam Ming Kwong, her husband, and her mother upon arrival. The purpose of the inspection was explained to them. There were 4 children that included 2 infants upon arrival. Licensee owns this 2 story single family house. Licensee lives in the house with her husband, her mother, and her sister. All adults have fingerprint clearance. The facility operation hours are Monday to Friday from 7:30am to 6:00pm. The daycare areas are the entire mid-level, and a deck in the back of the house. The off-limit areas are the entire lower and upper levels. LPA toured and inspected the facility for health and safety hazard. The house was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were either locked or made inaccessible to the children. There were plenty of the age appropriate toys, books, learning material, and children’s furniture available in the daycare. There were a fully charged 2A10BC fire extinguisher,working smoke and carbon monoxide detectors, and first aid supplies available in the daycare. Fireplace was blocked by a cabinet. Gates were used at the main entrance, kitchen entrances, stairway, & dining room entrance. Window locks were installed to the windows to limit the windows to be opened up to 4 inches in the living room. Cribs were used for napping. High chairs and booster were available for feeding only. All electrical outlets were covered. Diaper changing table was available in the dining area. All lower cabinets in the dining area were locked or free of dangerous items. All the lower kitchen cabinets and drawers were latched or free of dangerous items. Children’s bathroom was clean and free of harmful object. Carpet was installed to the entire play areas to prevent injury. The deck in the back of the house was clean. The deck was completely fenced. There was a play house available for the children. Licensee provides breakfast, AM/PM snacks, and lunch to the daycare children. Per licensee, one of the children brings his own meals to the daycare daily. Licensee and her husband who works as a helper already completed the Child Abuse Mandated Reporter Training (AB1207) - expire in 1/15/24 & 2/5/24, and Frist Aid/CPR - expire in 8/1/22. The licensee conducted the fire drill 2 times a year and logged. Per licensee, there were no children on special medication. Per licensee, there were no guns, weapons, or pets in the house. The facility had the touchless thermometer, and hand sanitizer available to prevent COVID19 in the daycare area.

This report was reviewed and provided to the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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