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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002604
Report Date: 03/06/2020
Date Signed: 03/06/2020 03:26:31 PM

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:LIN, SILANFACILITY NUMBER:
384002604
ADMINISTRATOR:LIN, SILANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 825-5877
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Silan LinTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst, LPA Yee conducted a required 1-year inspection today. The purpose of the inspection was explained. At 12:45 pm I range the doorbell. No answer. I called, no answer. LPA called licensee's daughter Tiffany (Jie Min Zhang), no answer and unable to leave a voice message due to voice messages are full. Licensee's daughter Jie Min Zhang is also a licensee located in the back of this facility. The two houses have adjoining fence/gate in the back. LPA enters this facility through Tiffany's facility. There are 11 (4 infants, 7 PreK) children and 2 teachers present today. One child left during the inspection. At 1:30 pm LPA toured the facility with a teacher. It appears that the licensee does not live here. The licensee is not present. Helper said licensee left to run some errands. Current residents are licensee, Silan Lin and her husband. All adults living or working in the home have a criminal background check on file. Days and hours of operation: Monday to Friday between 8:00 AM to 6:00 PM.

Day Care Areas: living/dining room, bathroom, bedroom, front yard and backyard. The home is free of hazards with proper temperature and ventilation. Per Tiffany, a carbon monoxide detector, smoke detector are working. A fire extinguisher is fully charged.

At 2:15 PM, LPA reviews the children's records and staff records. Some children's records are incomplete. LPA advised licensee to keep a current record. The licensee has a record of training of preventive health and CPR card valid until 4/28/2021. Licensee conducted fire and emergency drills once a month. The last drill was conducted on 2/12/2020.

Incidental Medical Services (IMS) policy was discussed. A written IMS is on file.
LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Tiffany said she can not find the AB1207 certificate at this moment and it is time to renew the certificate and will take the class soon.

LPA discussed the safe sleep regulation concepts and the handout was provided.
This report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for the next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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: LIN, SILAN
FACILITY NUMBER: 384002604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2020
Section Cited

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102352h: Home: It is the place where one remains when not called elsewhere for labor or other special or temporary purpose, and to which he or she returns in seasons of repose.

Licensee does not live here.
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This requirement was not met as evidence-based upon inspection, the licensee failed to maintain Title 22 requirement.

This poses a potential health risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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