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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001659
Report Date: 01/27/2020
Date Signed: 01/27/2020 01:53:42 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:KUANG, KARENFACILITY NUMBER:
384001659
ADMINISTRATOR:KUANG, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 239-1889
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
01/27/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Karen KuangTIME COMPLETED:
02:00 PM
NARRATIVE
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3, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. There are 11 children, licensee, Karen Kuang, helper, Qunxiu Tang, and husband, Huo Quan Kuang present today. The purpose of the inspection was explained. Current residents at the facility are the licensee, Karen, her husband, their son, son's girlfriend, daughter, her mom, and her dad. No change in the daycare areas as previously licensed. The entire upper level and garage areas are off-limit. Daycare areas (lower level): play areas, kitchen, bedroom #1, bedroom #2, bathroom and backyard. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. CPR & 1st aid is current until 2/4/2020. The licensee has already registered to renew the class on February 1st. Required immunization for staff members is on file. Child Abuse Mandated Reporter Training, AB1207 certificates for all staff members are on file. LPA reminded licensee that the training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com. The facility provides morning snacks, afternoon snacks, and lunches.
Incidental Medical Services (IMS) policy was discussed. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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 Centers and the ADA, Available at http://www.ada.gov/childqanda.htm The facility does provide IMS services to the children. Forms filled out by parents were reviewed. Karen said she will submit the IMS plan to CCL by the end of next month. Children's files were reviewed and complete. SIDS " A Child Care Provider's Guide to Safe Sleep" was provided today. Last emergency drills was conducted on 1/3/2020.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KUANG, KAREN
FACILITY NUMBER: 384001659
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2020
Section Cited

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H&S 1596.7995(a)(1) Staff Immunization:
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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**Staff/husband doesn't have proof of staff immunization's (measles, pertussis, Flu), for review during inspection.** Helper is missing MMR.

This requirement was not met as evidence-based upon records review. This poses a potential health risk to children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2020
LIC809 (FAS) - (06/04)
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