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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001158
Report Date: 12/14/2022
Date Signed: 12/14/2022 03:23:44 PM


Document Has Been Signed on 12/14/2022 03:23 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
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: 4DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Wan Zhen ChenTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, WanZhen Chen, and a helper, and explained the purpose of the inspection to them. All adults had fingerprint clearance. The children were napping upon LPA arrival. There were 4 children that included an infant. The facility had a daycare name that was called "Angel Family Day Care". The facility's operation hours were Monday and Friday from 8 AM to 5:30 PM. Licensee rents this 2 story single family house. Licensee lives in the house with her husband, her daughters (Minor), & her mother. All adults have fingerprint clearance. LPA toured and inspected the facility for health and safety hazard. The daycare areas were the entire lower level and backyard. The off-limit area was 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 7/27/24. 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, 15 minutes nap check log, and roster were reviewed during the inspection. LPA also obtained a copy of the roster during the inspection.
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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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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