384002486-3-24-2022-05-CC-BVAN-CCU2Q9-20220324173535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002486
Report Date: 03/24/2022
Date Signed: 03/24/2022 05:36:17 PM

Document Has Been Signed on 03/24/2022 05:36 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:	QIU, EILEEN		FACILITY NUMBER:	384002486
ADMINISTRATOR:	QIU, EILEEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 307-7035
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY:	14	CENSUS: 6	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Eileen Qiu		TIME COMPLETED:	05:00 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	On March 24, 2022, Licensing Program Analyst (LPA), Van, conducted an unannounced required annual inspection and met with Eileen Qiu. The purpose of the inspection was explained and granted entry to the home by the Licensee. Present today are six children (1 infant and 5 preschoolers) with the Licensee and a helper. The facility is in compliance with the staff-children ratios today. All adults living or working in the home have a criminal background clearance on file. The home is a two-level single-family house. The Licensee owns the house. Daycare areas are on the ground level, including a nap room, a family room, and a bathroom. Off limit areas are the entire second floor and the garage. All off-limit areas, including closets, and staircase, are adequately barricaded. The Days and operation hours are 8:30 am – 5:30 pm, Monday – Friday. Per Licensee, when a child shows signs of illness, the Licensee will separate and have the child waiting in the nap room while contacting the parent to pick up. LPA toured and inspected inside and outdoor play areas for health and safety hazards during the inspection. The daycare area is clean, orderly, and equipped with safe, age-appropriate toys, books, and play equipment. Cots are provided to older children for napping. The home has adequate heating, lighting, ventilation and is free from defects or conditions that endanger children in care. The home is equipped with a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a working telephone and cellphone. Fully stocked first aid supplies are available for children. All unused electrical outlets have a child-proof cover. Poisons, detergents, cleaning compounds are stored in a locked cabinet under the bathroom sink. Per Licensee, there are no firearms, weapons, or pets in the home. There are no pools, spas, or other bodies of water on the premises. LPA did not observe any walkers, bouncers, or any similar items. Licensee understands that smoking is prohibited in family child care homes.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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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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: QIU, EILEEN	FACILITY NUMBER: 384002486
	VISIT DATE: 03/24/2022

NARRATIVE

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The Licensee states the facility provides breakfast, lunch, and morning & afternoon snacks. Fire and Earthquake drills are conducted quarterly. The last drill was conducted on January 14, 2022. During the inspection, LPA reviewed records of all children present. The Licensee has complete records for children in care, including immunization records and Parents' Rights forms. LPA observed each child has a complete emergency information card with the child's full name, telephone number, and location of a parent or authorized representative to be contacted in an emergency. The name and telephone number of the child's physician and the parent's authorization for the Licensee to consent to emergency medical care. Licensee maintained a record of her immunization, a valid child care liability insurance in the file, and CPR/First Aid will expire on 1/9/2024. Licensee posted all the required forms, such as facility License, Notification of Parent's Rights, Earthquake Preparedness checklist, and Notification of Personal Rights.

LPA discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage https://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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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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: QIU, EILEEN	FACILITY NUMBER: 384002486
	VISIT DATE: 03/24/2022

NARRATIVE

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The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The report was reviewed and signed by the Licensee, Eileen Qiu. No deficiencies were observed in today's inspection. Today's report, 3/24/2022, and site visit notice will be sent to the Licensee email by the close of business on 3/24/2022. Confirmation of receipt is required, and a site visit notice must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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