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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002354
Report Date: 03/12/2020
Date Signed: 03/12/2020 09:15:04 AM

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:MAI, YI HONGFACILITY NUMBER:
384002354
ADMINISTRATOR:MAI, YI HONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 828-2245
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 3DATE:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Yi Hong Mai, BiYue YeTIME COMPLETED:
09:30 AM
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Licensing Program Analyst, LPA Yee conducted a required 1-year inspection today. The purpose of the inspection was explained. There are 3 children, licensee, Yi Hong Mai, and helper present today. Current residents are Yan Hong Mai, her husband, and their 3 children ages 13, 12, 8 years old. All adults living or working in the home have a criminal background check on file. Days and hours of operation: Monday to Friday between 8:00 AM to 5:30 PM.

LPA inspected the day-care areas with Yi Hong Mai. Day Care Areas (upper level): Living room, family room, kitchen, bedroom #3 (near the kitchen), bathroom (in the kitchen) and backyard. The remaining areas of the house are off-limits. Off limit areas are made inaccessible. The home is free of hazards with proper temperature and ventilation. Per Yi Hong Mai, a carbon monoxide detector, smoke detector are working. A fire extinguisher is fully charged.

At 8:30 PM, LPA reviews the children's records. Children's files are in order. The licensee has a record of training of preventive health and CPR card valid until April 20, 2021. The earthquake drill was conducted on 3/3/2020. A log sheet was reviewed.

Incidental Medical Services (IMS) policy was discussed. A written IMS plan is on file.
LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. All staff has been completed in AB 1207. A certificate is on file.

LPA discussed the safe sleep regulation concepts and the handout was provided.
This report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for the next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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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