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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001308
Report Date: 01/07/2022
Date Signed: 01/07/2022 04:19:32 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: 6DATE:
01/07/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Dong Gui LamTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection. LPA met with the licensee, Dong Gui Lam. The purpose of the inspection was explained to her. There were 6 children that included 3 infants with a helper present.. The licensee requested to add the backyard to her daycare areas. The LPA inspected the backyard for health and safety hazards. The backyard was completely fenced. There were some outdoor toys, swing and ride-on-toys available for the children. There was a gate at the hallway to the main entrance to prevent the children access to the off-limit.

the following item has to be completed before approval:
  • A gate has to be installed to the area in the back of the backyard. The area is used to store a buggy(Troller).



SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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