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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001019
Report Date: 02/14/2023
Date Signed: 02/14/2023 03:54:09 PM


Document Has Been Signed on 02/14/2023 03:54 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KAI MING HEAD START-RICHMONDFACILITY NUMBER:
384001019
ADMINISTRATOR:ELLEN PETERSON-ALLENFACILITY TYPE:
850
ADDRESS:426 33RD AVENUE, 2ND FLOORTELEPHONE:
(415) 386-3096
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:30CENSUS: 22DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Hong Yan Li (Kelly)TIME COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the Site Director, Hong Yan Li (Kelly), and explained the purpose of the inspection to her. LPA observed 22 children with 6 staff present. The children were napping upon LPA's arrival. All adults had fingerprint clearance. The facility located on the upper level in the Pine Methodist Church. There was another day care facility located on the lower level in the same building. The facility's operation hours were Monday to Friday from 8 AM to 5:30 PM. LPA inspected the facility for health and safety hazards. There were 3 classrooms such as Classroom 1, 2, and multipurpose classroom that next to the office. There were plenty of the age-appropriate toys, books, learning equipment and children's furniture available in each classroom. The children's furniture was in good repair and condition. There was a sink in classroom #1 & #2 available for the children. There was a children's bathrooms on site with total of 2 toilets, and 2 sinks were available for children. All toilets and sinks were reachable by children. All hot water on all children's sink were shot off, only has cold water. Cubbies were available for children's use. Separated staff bathrooms was available for staffs on the same floor. Isolation area for ill child was the director's office. Facility had an outdoor play area on the lower level with an outdoor space waiver for no more than 20 child at a time; Facility has also used the public park near by for outdoor play every day if weather permits. Cots were available for napping, Parents have taken the blankets home to wash every Friday. Facility has provided breakfast, lunch and snack for children via Chefable. The food preparation areas was clean and in order. The food waste bins had tide lids in the facility. Drinking water was served in water pitcher with cups for children indoor and outdoor, staffs brought water bottle with cups for outdoor. Facility has posted the required forms (ie License, menus, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Fire and Earthquake drills were done monthly and properly logged. The facility has used electronic Sign in/out system. The system was called." Jupiter" . At least a staff had current CPR & First Aid training at the center. All staff had current Mandated Reporter Training certificate for review. LPA also reviewed the children's files, and obtained a copy of the current children's roster during the inspection. There were couple of children on special medication. LPA inspected the storage of the medication and documents along with it during the inspection, The facility had an air purifier to provide clean air in each classroom.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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