384002397-10-5-2022-05-CC-JYEE-CJWPU9-20221005113709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002397
Report Date: 10/05/2022
Date Signed: 10/05/2022 11:37:40 AM

Document Has Been Signed on 10/05/2022 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:	GONG, YINGJUN		FACILITY NUMBER:	384002397
ADMINISTRATOR:	GONG, YINGJUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 602-8921
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	14	CENSUS: 12	DATE:	10/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	YingJun Gong		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Yee conducted an unannounced Required - 1 Year inspection today. LPA met with two helpers and 12 children and explained the purpose of the visit. The licensee arrived during the inspection. LPA verified the facility personnel summary report with the licensee and current. Current residents are Ms. Gong, her mom, her dad, and her 13 years old son. Days and hours of operation are Monday to Friday from 8:30 am to 5:00 pm. The licensee owns the home which is single level, a family home. DAY CARE AREAS (lower level): one large room, bathroom, and backyard. OFF-LIMIT AREAS: the entire upper level, garage. All off-limit areas are properly barricaded with child safety gates and locked doors. LPA toured the daycare areas with the helper. LPA observed the home to be in good repair with proper temperature and ventilation. There were a variety of age-appropriate toys and equipment in the home which were in good condition. There were no pools, spas, or bodies of water on the property. The backyard is enclosed with at least a 5ft high fence. The backyard is equipped with appropriate outdoor toys and equipment in good working condition. All cleaning supplies, poisons, and other chemicals were stored inaccessible to children behind child safety-locked cabinets. There was a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone on site. LPA verified the phone number with the licensee and she said it is current. Per Licensee, there are no weapons or firearms in the home. The last disaster drill was conducted on 9-23-22. A log sheet was reviewed. During the inspection, LPA reviewed 12 children's files and staff files, and staff files. Children's files and staff files are in order. LPA reviewed Licensee's Pediatric First Aid/CPR which is current and will expire on 3/6/2024. The helpers also have current CPR/1st aid which will expire on 10-02-2024

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GONG, YINGJUN	FACILITY NUMBER: 384002397
	VISIT DATE: 10/05/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During Inspection:
LPA discussed Child Abuse Mandated Reporter Training AB1207 with Licensee. As of January 1, 2018 all staff will be required to complete Child Abuse Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The licensee has completed AB1207 on 5/9/2021.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/childqanda.htm. A written IMS is on file.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

-Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2