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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002604
Report Date: 03/02/2022
Date Signed: 03/02/2022 06:36:56 PM


Document Has Been Signed on 03/02/2022 06:36 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:LIN, SILANFACILITY NUMBER:
384002604
ADMINISTRATOR:LIN, SILANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 825-5877
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 11DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Silan LinTIME COMPLETED:
05:30 PM
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Licensing Program Analysts, LPAs LPA Yee and Mok (certified Chinese Bilingual) conducted a Required - 1-year inspection today. The purpose of the inspection was explained. Present at the facility are 11 children, licensee, Silan Lin, helper, Bilan Zhang. Per Silan Lin current residents are the licensee, and her husband only. LPAs toured the house with Silan Lin and tried to review the children's roster and names of the children. Silan Lin has no knowledge of the children's names. Silan Lin said she doesn't know English. LPAs Yee and Mok spoke to Silan Lin in Cantonese. Silan Lin does not cooporate. Silan Lin kept saying she doesn't know English and walked away. LPAs reviewed the children's files and roster with a helper, Bilan Zhang. An hour later, Silan Lin's son-in-law arrived at the facility.
Day Care Areas: living/dining room, bathroom, bedroom, front yard, and backyard. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The facility's bathroom seems to be not in use by Silan. There is no evidence of personal hygiene. LPAs verified where Silan take shower. Silan Lin was not able to provide the answer. The last emergency drill was conducted on 11/12/21. A log sheet was reviewed. CPR & 1st aid was not available for review. The facility provides snacks for the children. The children bring their own lunches. The facility has a small rabbit inside the cage. A written IMS plan is on file. Child Abuse Mandated Reporter Training, AB1207 certificate was not available for review. LPA reminded the licensee that the training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com. LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at 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. Children's files and roster were reviewed. "Individual Infant Sleep Plan", LIC9227 was explained and provided. All infants shall be checked every 15 minutes and keep a log sheet. This report was explained to Ms. Lin in Cantonese. She said she understands. The facility annual fee is due on 3/10/2022. An invoice was provided today.
Website: www.ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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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