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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001308
Report Date: 08/20/2020
Date Signed: 08/20/2020 12:08:25 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:LAM, DONG GUIFACILITY NUMBER:
384001308
ADMINISTRATOR:LAM, DONG GUI S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 290-8549
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:14CENSUS: 7DATE:
08/20/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dong Gui LamTIME COMPLETED:
12:10 PM
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Licensing Program Analysts (LPA) Mok conducted an announced Tele inspection with a licensee, Dong Gui Lam via FaceTime to complete the case management for adding room today. Per licensee's request, she wanted to add the lower lever (in-law) with two rooms and one bathroom to the daycare. The facility had 7 children with a staff present during the inspection. LPA toured the in-law for health and safety hazards. The in-law is located on the ground floor. It has 2 rooms and 1 bathroom. There is a side door existing to the side hallway to the front gate. There were plenty of age-appropriate toys, books, and children's furniture available for the children. There was a gate installed at the stairway to prevent children from accessing the off-limit areas. The side door, door to the garage, and sliding door have been installed the bells to prevent the children from opening the doors access to the off-limit areas. Licensee also installed the soft cushioning to the entire floor to provide a safe environment. All electrical outlets were covered. The licensee installed the Sprinkler system in the in-law. Licensee also had a fully charged 2A10BC fire extinguisher available on the same floor. Children's bathroom was available for the children. The bathroom was clean. The lower bathroom cabinet and drawers were free of harmful objects. LPA also discussed with licensee about all children have to nap on the same floor under care and supervision by staff. The in-law was approved to include in the daycare area as of today.

This report was provided to the licensee via e-mail. The licensee needs to send a copy of the report with her signature back to LPA either via e-mail or mail.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020
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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