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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002633
Report Date: 09/20/2019
Date Signed: 09/20/2019 12:37:49 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:ZHENG, SHI YINGFACILITY NUMBER:
384002633
ADMINISTRATOR:ZHENG, SHI YINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 601-7480
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:14CENSUS: 10DATE:
09/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Shi Ying ZhengTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual increased inspection today. LPA met with the licensee, Shi Ying Zheng (Michelle), and her husband (helper) who has fingerprint clearance. The purpose of the inspection was explained to her. Licensee is a primary Chinese Speaker. There were 10 children included 1 infant present with a helper. Licensee owns this 2 story single family house. The house 3 bedrooms, 1 bath on the upper level, on the lower level has 2 bedrooms, and 1 bath. Day-care areas are the entire downstairs including: an in-law, and backyard. The off-limit areas are the entire upper level, on the lower level including a bedroom in the front, kitchen area, and a bathroom by the main entrance. LPA toured and inspected the facility for health and safety hazard. The facility was clean and in order. All toxins and harmful objects were locked and made inaccessible to children. There were plenty of the age-appropriated toys, children's books, and furniture in the day care area. All children’s items were in good condition. There were the fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detectors, working telephone, and first aid supplies available in day care. All electrical outlets have built in cover to prevent children access it. Barricade was used at the entrance of the kitchen area to prevent children access. Right amount of cubbies were available for the children to store their own belongings. There was a changing table with a sink next to it available in the food preparation area. There was a bathroom for children available next to the diaper changing area as well. Bathroom was clean and all cabinets were cleared with toxin and harmful objected. Cots and crib were available for napping. Child proof knobs were installed on the doors to prevent children access to the off-limit areas. Licensee provides breakfast, AM/PM snacks, lunch and dinner to the day care children or children can bring their own food to the day care. All sharp corners were covered. All lower cabinets were latched. The Outdoor play area was completely fenced. Part of the outdoor play area with shade, so the children can have outdoor activity during rainy day. Licensee installed the soft cushioning to the entire outdoor play area to prevent injury. There were plenty of age appropriate outdoor toys, play structure with slides and ride-on toys available for children. Licensee and her husband had current CPR/First aid that will expire in 3/2021. The latest drill was conducted in 6/2019. Per licensee, there was one child on special medication. 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 Family Child Care Homes Section 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 facilities and the ADA, available at: http://www.ada.gov/childqanda.htm. All required postings were posted. Children files and roster were reviewed during inspection. Children file was reviewed during the inspection. Licensee and her helper had staff immunization.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. A Child Care Provider's Guide to Safe Sleep was provided to licensee during visit. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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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