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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506419
Report Date: 07/19/2019
Date Signed: 07/19/2019 10:29:02 AM

COMPREHENSIVE INSPECTION
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:CHUNG, YU MEIFACILITY NUMBER:
380506419
ADMINISTRATOR:CHUNG, YU MEIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 759-1057
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:14CENSUS: 3DATE:
07/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Chung, Yu MeiTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Van performed an unannounced random annual inspection at the above facility. LPA met with licensee YuMei Chung and her helper YuFang Xie, the purpose of the inspection was explained. Present at the home are 3 children in care (2 infants and 1 preschool). The facility is operating within licensed capacity and within ratio on this day. LPA inspects inside of the facility for health and safety hazards. Hours of operations are Monday – Friday from 8:30AM – 6:00PM. Day care areas are the living room, playroom, the bathroom, and kitchen. Off Limit areas are all bedrooms, garage, backyard, and 2nd floor level. Licensee states that sick children will be separated from the group and will be waiting in the living for parents to pick up.

LPA did not observe any bodies of water on the facility. Per licensee, there are no firearms or weapons in the home. Cleaning supplies and chemicals are inaccessible to children, they are stored under the kitchen sink and locked away with child proof locks. LPA observed each room has a carbon monoxide and smoke detector installed. There is a fully charged fire extinguisher that meets minimum size requirements in the kitchen. The home is clean and in well repair. There are sufficient amounts of age appropriate furniture, toys and reading materials available to children. There are an adequate lightning, ventilation, and comfortable temperature in the home. Table and furniture have round cushions installed to prevent any injury.

LPA reviewed children’s and staff’s files. Children files have immunization records and signed parent’s rights notification forms. Licensee First Aid and CPR will expire on 4/7/2020. Licensee has all immunization completed and records are on file. Discipline policy is discussed with licensee. Licensee states her discipline method will be talking to the child, and redirection

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHUNG, YU MEI
FACILITY NUMBER: 380506419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2019
Section Cited
ILS
102417(g)(8)
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102417 Operation of a Family Child Care Home. (g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
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The licensee will send copy of the children roster by 7/26/19.
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(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met evidenced by records review, licensee wasn't able to provide LPA the children roster. This poses a potential Health and Safety risk to children in care.
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Type B
07/26/2019
Section Cited
CCR
102421(b)
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102421- Child's Records. (b)The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7)
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The licensee will send copy of the children roster by 7/26/19.
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This requirement is not met evidenced by records review, C3 did not have emergency information card. This poses a potential Health and Safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CHUNG, YU MEI
FACILITY NUMBER: 380506419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2019
Section Cited
CCR
102419(d)
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102419- Admission Procedures and Parental and Authorized Representative's Rights. (d) At the time of acceptance of each child into care, the licensee shall
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provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06), the Caregiver Background Check Process Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met evidenced by records review, C3 did not have Parent's Rights form on record. This poses a potential Health and Safety risk to children in care.
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Type B
07/26/2019
Section Cited
HSC
1597.622(a)(1)
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§1597.622- Employee and Volunteer Immunization. (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family
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day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met evidenced by records review, licensee's helper does not have any immunization records on file. This poses a potential Health and Safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CHUNG, YU MEI
FACILITY NUMBER: 380506419
VISIT DATE: 07/19/2019
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LPA reminds licensee 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.

LPA reviews AB 1207 with the licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Licensee and helper are exempt at the moment, English are not their primary language.

See LIC 809D on the next page for deficiencies that are cited on this day. A copy of this report is reviewed with licensee, along with a notice of site visit which is to be posted for 30 days. Records to be maintained are explained to licensee. Licensee is informed for quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
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