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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505563
Report Date: 06/09/2022
Date Signed: 06/09/2022 02:58:13 PM


Document Has Been Signed on 06/09/2022 02:58 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:KAI MING HEAD START-DR. T. KONG LEE CENTERFACILITY NUMBER:
380505563
ADMINISTRATOR:LEI, IOKFACILITY TYPE:
850
ADDRESS:950 POWELL STREETTELEPHONE:
(415) 982-4777
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94108
CAPACITY:20CENSUS: 14DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Kun Fun (Winnie) Lei & Zixin (Kaylee) HuangTIME COMPLETED:
01:30 PM
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On June 09, 2022 at approximately 11:15am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Required - 1 Year Visit at and met with Lead Teacher Kun Fun (Winnie) Lei & Family Advocate Zixin (Kaylee) Huang during the visit. Purpose of the inspection was explained. There were 5 staff members including Head Teacher providing care to 14 children. Staff to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The center uses a clip board for parents to sign their children in/out of the center. All children were signed into the system. Facility Manager Susanna Leung and Regional Manager Gabriela Rivera arrived at facility approximately thirty minutes into the inspection.

LPA and Lead Teacher inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Lead Teacher, there are no firearms or weapons in the center. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in backpack inaccessible to children and staff able to carry with them when leaving school for field trips. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The food prep area is clean and orderly. The center provides breakfast, lunch with outside vender Chefable and afternoon snack and has a vendor lunch. Menus are posted in the center. All solid waste storage containers have tight fitting lids. Last Emergency Drill was conducted on 06/01/2022 and properly logged.

At 12:00pm, A random sample of children's and staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location.

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KAI MING HEAD START-DR. T. KONG LEE CENTER
FACILITY NUMBER: 380505563
VISIT DATE: 06/09/2022
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This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA discussed Child Abuse Mandated Training AB1207 with facility representative. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with facility representative. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

An Exit Interview was conducted with Regional Manager. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and will be emailed to Regional Manager and Facility Manager whose signature on this form confirm have read these reports. Notice of Site Visit will also be emailed. Notice to remain posted for 30 days. For updates 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: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2