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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000146
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:15:01 PM


Document Has Been Signed on 05/24/2022 03:15 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:LEE, DEANNAFACILITY NUMBER:
384000146
ADMINISTRATOR:LEE, DEANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 337-8602
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 3DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Deanna LeeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst, LPA Yee conducted a Required - 1-year inspection today. The purpose of the inspection was explained. Present at the facility are licensee, Deanna and three daycare children. Current residents are Deanna, her husband, their two children ages 11 years old and 8 years old. Day-care areas (lower level): large playroom, bedroom on the left, bathroom, kitchen and backyard. The remaining areas of the house are off-limits. The facility personnel summary report was reviewed with Deanna and he said it's current. Days and hours of operations are from Monday - Friday, 8:30 a.m. - 5:30 p.m.
The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The licensee has current CPR & 1st aid. Child Abuse Mandated Reporter Training, AB1207 certificate on file. An emergency drill was conducted on 5/4.
LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. Children's files were reviewed. The staff files were reviewed.
A blank form of LIC9227 was explained and provided.

Website: www.ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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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