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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000990
Report Date: 03/11/2020
Date Signed: 03/11/2020 09:23:45 AM

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:LIU, YAN LIFACILITY NUMBER:
384000990
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
03/11/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Yan Li LiuTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst, LPA Yee conducted a required 1-year inspection today. The purpose of the inspection was explained. There are 6 children enrolled. Children usually arrived around 9am. Currently, she has 2 children and licensee present today. Current residents are Yan Li Liu, her husband, her son and her daughter in law. All adults living or working in the home have a criminal background check on file. Days and hours of operation: Monday to Friday between 7:00 AM to 6:00 PM.

LPA inspected the day-care areas with Yan Li Liu. Day Care Areas (lower level): Living room, kitchen, bedroom #1, bedroom #2, bathroom and backyard. The remaining areas of the house are off-limits. Off limit areas are made inaccessible. The home is free of hazards with proper temperature and ventilation. Per Yan Li Liu, a carbon monoxide detector, smoke detector are working. A fire extinguisher is fully charged.

At 8:30 PM, LPA reviews the children's records. Some children's files are in complete. LPA advised licensee to keep current records. She said she understands. The licensee has a record of children’s immunization. The licensee has a record of training of preventive health and CPR card valid until June 03, 2020.

Incidental Medical Services (IMS) policy was discussed. Licensee stated no children in her care need the services at this time.
LPA review 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 completed AB 1207 on 8/17/2019. A certificate is on file.

LPA discussed the safe sleep regulation concepts and the handout was provided.
This report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for the next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
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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