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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002354
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:37:54 AM


Document Has Been Signed on 03/30/2022 11:37 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:MAI, YI HONGFACILITY NUMBER:
384002354
ADMINISTRATOR:MAI, YI HONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 828-2245
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yi Hong MaiTIME COMPLETED:
12:00 PM
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Licensing Program Analyst, LPA Yee conducted a Required - 1-year inspection today. The purpose of the inspection was explained. Present at the daycare are 10 children(4 infants), Yi Hong, her husband, and a helper. LPA toured the house with Yi Hong. Current residents are Yi Hong, her husband, and their children ages 15, 14, 9. The facility personnel summary report was reviewed with Yi Hong and she said it's current. Her children are on Easter break and home. Day Care Areas: living room, family room, kitchen, bedroom #3 located next to the kitchen, bathroom located inside the kitchen, and backyard. The backyard is not being used at this time due to the downstairs level is being remodeled. LPA informed the Licensee about the "Minor Renovation and Repairs Grant". She said she is aware of it and has already applied for the grant. The planning department has already inspected the lower part of the rooms. Once the remodeling is completed, she will notify the licensing office.
The remaining areas of the house are off-limits. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The licensee, CPR & 1st aid are current until 3/7/2023. The facility provides meals for the children. Child Abuse Mandated Reporter Training, AB1207 certificate is current, completed on 2/23/21. Husband and helper have current AB1207 certificate on file. Required immunizations are on file. LPA reminded the licensee that the training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com. Liability insurance 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. The roster was reviewed. "Individual Infant Sleep Plan", LIC9227 was on file for infants who are less than 12 months old. Infants were checked every 15 minutes and a log sheet was reviewed.

Website: www.ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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