384001921-10-11-2022-05-CC-JYEE-CK4PPS-20221011113002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001921
Report Date: 10/11/2022
Date Signed: 10/11/2022 11:30:39 AM

Document Has Been Signed on 10/11/2022 11:30 AM - It Cannot Be Edited

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:	FANG, HELEN QI WEN		FACILITY NUMBER:	384001921
ADMINISTRATOR:	FANG, HELEN QI WEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 730-8148
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 10	DATE:	10/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Helen Qi Wen Gang		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Yee conducted an unannounced Required - 1-year inspection today. The purpose of the inspection was discussed. Present at the facility are the licensee, Helen, 2 helpers, and 10 daycare children (4 infants, and 6 preschoolers). The facility personnel summary was reviewed with the licensee and she said it is current. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00 am to 5:30 pm. The licensee owns the home. Current residents are the licensee, her husband, her dad, her mom, her brother, and sister in law. The DAYCARE AREAS (2nd floor): The entire level is for day-care and backyard; except the storage room, staff bathroom, and kitchen. The remaining areas of the house are off-limits. The fire clearance is on file LPA toured the daycare areas of a home with the Licensee. LPA observed the home to be in good repair with proper temperature and ventilation. There were a variety of age-appropriate toys and equipment in the home which were in good condition. There were no pools, spas, or bodies of water on the property. The backyard is enclosed with at least a 5ft high fence. The backyard is equipped with appropriate outdoor toys and equipment that are in good working condition. All cleaning supplies, poisons, and other chemicals were stored inaccessible to children behind child-safety locked cabinets. The home is equipped with a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone on site. Per Licensee, there are no weapons or firearms in the home. The last emergency drills and earthquakes were conducted on 10-03-22 and 9-30-22. She stated that she conduct emergency monthly. LPA reviewed 10 children's files and 2 staff members' files in order.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

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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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: FANG, HELEN QI WEN	FACILITY NUMBER: 384001921
	VISIT DATE: 10/11/2022

NARRATIVE

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LPA reviewed Licensee's Pediatric First Aid/CPR which is current and will expire on 8-14-24.

This facility provides Incidental Medical Services - IMS. LPA reviewed the 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 licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

LIC809 (FAS) - (06/04)

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