384002024-2-2-2023-05-CC-JYEE-CNNUZ7-20230202150104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002024
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:01:29 PM

Document Has Been Signed on 02/02/2023 03:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LI, QIU MEI		FACILITY NUMBER:	384002024
ADMINISTRATOR:	LI, QIU MEI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 239-2137
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 10	DATE:	02/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Qiu Mei Li		TIME COMPLETED:	03:30 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 explained. LPA met with Qui Mei, 3 helpers, and 10 children (3 infants). The facility personnel summary report was reviewed with Qui Mei, she said it's correct. The current residents are Qui Mei, her husband, and their 16-year-old son. The facility operation hours are Monday - Friday, 8:30 am - 5:30 pm. Daycare areas are a front yard for outdoor activities, living room, studio room, half bathroom located inside the studio room, full bathroom near the kitchen, dining room, and kitchen (inspected, added today per the licensee request). The remaining areas of the home are off-limits. The home is clean orderly and properly ventilated. The home is equipped with a fully charged fire extinguisher size 2A10BC, smoke detectors, and carbon monoxide. The smoke detector and carbon monoxide are in working condition. There is no swimming pool or hot tub on the premises. All harmful objects such as sharp, chemicals, detergents, cleaning compounds, and medication are made inaccessible to children in care. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects, toxic, cleaning products, and household items inaccessible to children. First aid supplies are available for children. The last fire drill/earthquake was conducted on 1/5/2023. The disciplinary policy was discussed with Licensee today. The home has age-appropriate toys and equipment available for the children in care. LPA reviewed the children's roster and staff records. continue to the next page.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LI, QIU MEI	FACILITY NUMBER: 384002024
	VISIT DATE: 02/02/2023

NARRATIVE

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Licensee’s CPR and 1st aid certificate is current and will expire on 03/07/2023.

LPA discussed Child Abuse Mandated Reporter Training AB1207 with Licensee. As of January 1, 2018, all staff will be required to complete Child Abuse Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

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. A written IMS is on file.

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 posted and shall 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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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