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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002423
Report Date: 07/06/2022
Date Signed: 07/07/2022 01:01:38 PM


Document Has Been Signed on 07/07/2022 01:01 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:YAN, XIAO LING & CHEN, MELODY HUAFACILITY NUMBER:
384002423
ADMINISTRATOR:YAN, XIAO LINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 333-3040
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 4DATE:
07/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yan, Xiao LingTIME COMPLETED:
12:15 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 Xiao Ling, her husband, and 4 children (1 infant). Residents at the facility are Xiao Ling, Melody Hua, and Xiao's husband. No tenant. The facility personnel summary was reviewed with Xiao and she said both tenants listed on the summary report moved out a long time ago. She has requested to remove both tenants from the list during the visit. Day-care areas (lower level): kitchen, library, activities room, nap room located in the back, bathrooms, backyard, and living room located on the 2nd floor. The backyard is not being used at this time due to the weather. The remaining areas of the house are off-limits.
The facility is equipped with a 2A10BC fire extinguisher, smoke detectors, and carbon monoxide. The licensee's husband tested it during the inspection and work. CPR, 1st aid certificate is current until 4/4/2023. The last earthquake drill was conducted on 6/24/22. The facility has age-appropriate toys and equipment for the children.
The facility participates food program. LPA reviewed 4 children's files. During the inspection, Melody came into the daycare from upstairs. Some children's files are incomplete. LPA explain the requirements and provided some blank forms.
Both licensee and co-licensee AB1207 certificate has expired.
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.
Melody said she has signed up to take the class from the Children Council and will submit the certificate by August 30, 2022.
LPA discussed the safe sleep regulations with the 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 the 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. A blank form of lic9227 was provided and explained.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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