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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002354
Report Date: 09/06/2022
Date Signed: 09/06/2022 07:55:31 PM


Document Has Been Signed on 09/06/2022 07:55 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:MAI, YI HONGFACILITY NUMBER:
384002354
ADMINISTRATOR:MAI, YI HONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 828-2245
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 9DATE:
09/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Yi Hong MaiTIME COMPLETED:
04:00 PM
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Licensing Program Analyst, LPA Yee conducted a case management inspection today. The purpose of the inspection was explained. Present at the facility are licensee, 2 helpers and 9 children. This facility remodeled her lower level for a large daycare. Fire Marshall had inspected the facility and fire clearance was granted on 7/15/2022. The lower level consists of a large room, a kitchen, two bathrooms, garage, side yard and backyard.

Daycare areas (lower level): Large room, kitchen, both bathrooms, side yard and backyard. Off limit areas: the entire upper level, and garage.

Based on today's physical inspection, LPA approved the usage of the lower level areas for the daycare.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022
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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