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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002038
Report Date: 01/12/2023
Date Signed: 01/12/2023 10:38:43 AM


Document Has Been Signed on 01/12/2023 10:38 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:PUN, CHUNG YINFACILITY NUMBER:
384002038
ADMINISTRATOR:CHUNG YIN PUN(PEGGY)FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 831-1426
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:14CENSUS: 2DATE:
01/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Pun, Chung Yun and Lui, Hoi YeeTIME COMPLETED:
10:45 AM
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 On January 12, 2023., licensing program analyst Van conducted an announced case management inspection and met with the Licensee, Chung Yin Pun. The purpose of the inspection was explained to the Licensee, and it was to obtain a complete and up-to-date facility children's roster. Present at home was the Licensee, and her adult daughter, Lui Hoi Yee, supervised two children. Licensee's adult daughter lives next door and has a Family Child Care Home license of her own, but the license is currently inactive.
The Licensing Department requested the facility children's roster from the Licensee a few weeks ago. The Licensee complied with the request and sent it to the licensing office. However, the facility roster was incomplete and not adequately maintained. During today's inspection, LPA discussed the children's roster with the Licensee and her daughter and informed the Licensee that the children's roster must be maintained for three years. The roster record should include currently enrolled children and those no longer attending.
During the inspection, the Licensee's daughter created a new children's roster list and provided it to LPA.
The Licensee read and signed the report. Notice of the site visit and today's report was provided to the Licensee. LPA informed the Licensee that a site visit notification must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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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