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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001158
Report Date: 11/19/2019
Date Signed: 11/19/2019 04:38:23 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:CHEN, WANZHENFACILITY NUMBER:
384001158
ADMINISTRATOR:CHEN, WANZHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 831-6534
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:14CENSUS: 11DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Wan Zhen ChenTIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced increased inspection today. LPA met with the licensee, and her helper who has fingerprint clearance. The purpose of the inspection was explained to her. There were 11 children included 4 infants. The children were napping upon LPA arrival. Licensee rents this 2 story single family house. Licensee lives in the house with her husband, her son (Minor), her mother and a roommate. All adults have fingerprint clearance. LPA toured and inspected the facility for health and safety hazard. The daycare areas are the entire lower level and backyard. The off-limit area is the entire upper level. Gate was installed at the stairway to prevent children access to the upper level. The house was clean and in order. Temperature and lighting were adequate. Toxins and harmful items were either locked or made inaccessible to children. All electrical outlets were covered. Fireplace was blocked. There were a fully charged 2A10BC fire extinguisher, working telephone, and first aid supplies available in the daycare. Smoke and carbon monoxide detectors were not tested due to napping. Per licensee, there were no guns, no weapons, and no pets in the house. All the lower kitchen cabinets and drawers were either latched or free of harmful objects. Cots and cribs were used for napping. High chairs were available for feeding only. There were plenty of age-appropriate toys, books, learning material, and children’s furniture available in the daycare. Gate was installed at the kitchen entrance to prevent children access. Children’s bathroom was clean and free of harmful object. The outdoor play yard was completely fenced. Soft cushioning was installed to the entire ground to prevent injury. There were plenty of age appropriate outdoor toys, play house, play structure, and ride-on-toys available for children. Gates were installed at the outdoor stairway. Facility provides breakfast, AM/PM snacks and lunch to the children. Licensee and her helper had current CPR/First Aid certificates available for review during the inspection. The certificates will be expired on 7/7/2020. Per licensee, there were no children on special medication. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care facilities and the ADA, available at: http://www.ada.gov/childqanda.htm. All required postings were posted. Children files and roster were reviewed during the inspection. LPA also obtained a copy of the roster during the inspection. Licensee and her helper completed the Child Abuse Mandated Reporter Training (AB1207).

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. A Child Care Provider's Guide to Safe Sleep was provided to licensee during inspection. Notice of site visit was provided. 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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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