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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000668
Report Date: 06/27/2019
Date Signed: 06/27/2019 03:56:04 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:CAI, XIU HUA & LAU, OLIVIA W.FACILITY NUMBER:
384000668
ADMINISTRATOR:CAI, XIU HUA & LAU, OLIVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 203-0598
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:14CENSUS: 10DATE:
06/27/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Licensee, Olivia LauTIME COMPLETED:
04:10 PM
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Licensing Program Analysts (LPAs), Cindy Interiano and Jennifer Yee, met with Licensee, Olivia Lau. Purpose of the inspection was explained and was for a POC (Plan of Corrections) inspection. Present in the home is Licensee and Helper caring for 10 children (4 infants and 6 PreK). Licensee is within capacity limits of a Large License. Licensee has posted Type A deficiency and Notice of Site Visit from previous inspection next to the License. LPAs reviewed children’s files and reviewed all LIC 9224 (Acknowledgment of Receipt of Licensing Reports) signed by Guardians.

Deficiencies issued on 06/18/19 are the following:
*102416.5(a) Staffing Ratio and Capacity – 8 infants and 6 preK children were observed during an inspection conducted by IB Investigator on 02/21/19.
>Licensee has since disenrolled 4 infants, reducing her capacity. Capacity limits of a Small and Large License has been reviewed with Licensee. Licensee was reminded that when operating at a Large capacity, there must be a Helper present.
*102416.3(a)(6)(2) Changes made to the facility – IB investigator observed an unlatched gate leading to 2nd level and the approved daycare area does not match Facility Sketch on file.
>Licensee states she is now making sure the latch on the gate leading to the upstairs level is always placed. Licensee will be submitting a Facility sketch of the first and second level of the home.
*102417(g)(10)Operation of a Family Child Care Home. Two (2) baby bouncers were observed during IB Investigator’s inspection on 02/21/19. Two (2) baby bouncers were also observed by LPAs on 06/18/19.
>Licensee has since removed the baby bouncers from the Daycare area.
*102352 Co-Licensee does not reside in the home.
>Licensee and Co-Licensee will be requesting removal of Co-Licensee from the License.
*102416(b) Reporting Requirements.
>Licensees states they now understand the reporting requirements of unusual incidents: calling within 24 hours and submitting an LIC 624 within 7 days.

Deficiencies issued on 06/18/19 have been cleared.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Ch. 1

This report and rights to comment and appeal were discussed with Licensee. This report must be kept in the facility available for public review. Notice of site visit was observed being posted.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019
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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