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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001605
Report Date: 08/27/2019
Date Signed: 08/27/2019 03:36:14 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:FORDE, KELLY E.FACILITY NUMBER:
384001605
ADMINISTRATOR:FORDE, KELLY E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-4123
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94131
CAPACITY:14CENSUS: 12DATE:
08/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kelly FordeTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Kelly Forde, and her staff. The purpose of the inspection was explained to them. All adults are fingerprinted. There were 12 children present. All children were napping upon LPA arrival. Licensee owns this 3 level single family house. Licensee lives in the house with her husband and her 3 minor children. The daycare operation hours are Monday to Thursday from 8AM to 5PM. A bedroom next to the dining room was inspected and added to the daycare areas during the inspection. The daycare areas are the entire 2nd level except a bathroom next to the kitchen. The off-limit areas are the entire 1st level and 3rd level, and a bathroom next to the kitchen on the 2nd level. The main entrance of the facility from the right side door on the lower level (1st level). Children pass thru the alley into the backyard. The children enter the main daycare areas on the 2nd level from the backyard to the Playroom that faces to the backyard. LPA toured and inspected the facility for health and safety hazard. Temperature and lighting were adequate. All toxins and harmful objects were either locked or made inaccessible to the children. Right amount of cubbies were available for children to store their own belongings in the play room. There were plenty of age-appropriate toys, books, learning material and children furniture available for the children. 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 during the inspection. A Fire place was blocked. Play pens and Cots were used for napping. The children bathroom is located in the play room. It was clean. LPA didn't observe any harmful objects that were accessible to the children there. The lower sink cabinet was free of harmful or toxin items. The outdoor area was completely fenced. Artificial grass was installed to the entire ground as the soft cushioning to prevent injury,. There were plenty of the outdoor toys and play structure available for the children. Facility provides AM/PM snacks and lunch to the daycare children. Facility conducts the fire drill quarterly. The latest drill was conducted on June 5, 2019. Per licensee, there are no guns and weapons in the house. Per Licensee, she has a dog that is kept in the off-limit area. 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 by the side entrance. LPA reviewed the children files and roster during the inspection. LPA also obtained a copy of the roster during the inspection. LPA discussed with licensee about the Mandated Reporter Training (AB1207) that has to be completed by licensee and all staff 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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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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