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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001308
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:19:10 AM

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:
12/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Dong Gui Lam and Anna WangTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection. LPA met with the licensee,, Dong Gui Lam and her helper, Anna Wong. LPA explained the purpose of the inspection. There were 7 children that included 3 infants present with a helper. Licensee owns this 4 story single family house. Licensee lives in the house with her son, her son's girlfriend, and her daughter who is minor. Day care areas are the entire second level including, the living room, kitchen/dining area, and entire ground level. The off-limit areas are the entire upper level and third and fourth floor. LPA inspected the facility for health and safety hazards. There were a fully charged 2A10BC fire extinguisher, working smoke detectors, and first aid supplies. There were plenty of the age appropriate toys, books, learning materials, and children's furniture available. Per licensee, there is no pet, no firearms or weapons in the home. Facility conducts fire drills at lease once every six months and was properly logged. There are plenty of variety of children's toys, tables, chairs and equipment that are available for children in the day care area and all appeared to be safe and age appropriate for children. If there were ill child, staff would separate them in the nap room while waiting for parent to pick them up. Licensee is utilizing the children's roster and it is updated. Parents rights poster and the License are posted. Licensee and her helpers all have current pediatric CPR and First Aid training. Facility provides meal to children. The facility had the hand sanitizer, touchless Thermometer, and disinfectant available to prevent COVID19.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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