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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000990
Report Date: 03/23/2022
Date Signed: 03/23/2022 11:58:29 AM


Document Has Been Signed on 03/23/2022 11:58 AM - 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:LIU, YAN LI & LI, JINGJINGFACILITY NUMBER:
384000990
ADMINISTRATOR:LIU, YAN LIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 333-6028
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 8DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yan Li LiuTIME COMPLETED:
12:20 PM
NARRATIVE
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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 daycare are 8 children, licensee, Yan Li Liu. Yan Li's husband, son, and 8 daycare children. JingJing Liu is not present during the inspection. Current residents are Yan Li, her husband, her son, David, her daughter-in-law, and her 1-year-old granddaughter. The facility personnel summary report was reviewed with Yan Li and he said it's current. Day Care Areas: living room, dining room bathroom, bedroom #1, and backyard. The remaining areas of the house are off-limits. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The licensee, CPR & 1st aid are current until 06/2022. The facility provides meals for the children. Child Abuse Mandated Reporter Training, AB1207 certificate is expired. Yan Li said she will renew it and submit proof by the end of the month. LPA reminded the licensee that the training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com. Liability insurance is on file. 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. LPA also informed the licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. The roster was not available. LPA provided a blank copy and keep it current. Yan Li said she understands. "Individual Infant Sleep Plan", LIC9227 was explained and a blank copy was provided. Infants were checked every 15 minutes and a log sheet was reviewed. Jing Jing arrived at the facility during the inspection.

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: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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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