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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506419
Report Date: 09/03/2019
Date Signed: 09/03/2019 04:28:46 PM

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: 1DATE:
09/03/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Pei HuTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Van met with licensee's mom, Pei Hu, for an announced inspection of Plan of Correction (POC). The purpose of the inspection was explained and was granted entry to the home by licensee's mom. Present, there is one child at the day care. Licensee came home during records review.

On July 19, 2019 inspection, the following deficiencies were cited; Licensee did not have current roster of children, emergency identification card, Notification of Parents’ Rights, and missing immunization record for an employee. In today's POC inspection, LPAs inspected the facility for health and safety to verify the correction of the previous deficiencies.

During today's inspection, children and staff records were reviewed and confirmed that all deficiencies that were cited on July 19, 2019 cleared.

An exit interview was conducted with licensee. A consultation provided. No deficiencies are cited today. A copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
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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