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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002310
Report Date: 07/12/2022
Date Signed: 07/12/2022 03:43:49 PM


Document Has Been Signed on 07/12/2022 03:43 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:LEVY, SUMI LEEFACILITY NUMBER:
384002310
ADMINISTRATOR:LEVY, SUMI LEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 846-8119
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:14CENSUS: 9DATE:
07/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Hae Eun Yoon ( Helper)TIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with a helpers, Hae Eun Yoon. The purpose of the inspection was explained to them. LPA also met with another helper, Hey Eun Kang who provided care and supervision to the children who were napping upon LPA's arrival. There were 9 children with 2 helpers present. All the adults were fingerprinted. Per Hae, the licensee, Sumi, was on vacation. She will be back next week. The facility was a Korean Immersion facility. The daycare's entrance was on the left side of the garage. The facility was called "DOREMI KIDS". The facility's operation hours were Monday to Friday from 8:30 AM to 5:30 PM. The licensee rented this 2-story single family house. The house had two bedrooms, 1 bath, a living room, dining room and the Kitchen on the second floor. The ground level has one bedroom, one bath, a play room and the garage. The daycare areas were on the ground level including two playrooms, a bathroom, and a backyard. The off-limit areas were the entire upper level, and a garage. LPA inspected the facility for health and safety hazards. The facility was clean and in order. The temperature and lighting were adequate. There were a fully charged 2A10BC fire extinguisher, and first aid supplies available in the facility. LPA did not test the smoke and carbon monoxide detectors due to children were napping during the inspection. There were right amount of hooks for the children to hang their personal belongings in the entrance hallway. There were plenty of the age-appropriate toys, books, learning materials, and children's furniture that were in good condition and repaired, The children's bathroom was clean. All the toxins and harmful objects were made inaccessible to the children. There was a small food preparation area. The lower sink cabinet was free of harmful objects. All the electrical outlets were covered. Mats were used for napping. The outdoor play area was completely fenced. The outdoor play area was clean and in order. LPA didn't observe any harmful objects in the yard. There were some outdoor toys, play structures with soft cushioning underneath to prevent injury, Per Hae, there were no guns, no weapons, and no pets in the facility. The facility has provided Breakfast, & PM snack to the children only. The children have brought their own lunch to school. Their lunches were kept in their own bags and kept it in the children's storage area. Per Hae, there were no children on special medication. LPA reviewed the staff and children files during the inspection LPA also obtained a copy of the current children's roster from the facility during the inspection . The helpers had current CPR/FIRST AID training, they will expire in 7/2024 and 6/2023. At least a helper also had current Child Abuse Mandated Reporter Training (AB1207), it will expire in 7/2024. The facility has conducted the emergency drill monthly and logged,

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022
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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