384002633-10-17-2022-05-CC-NGAA-CKAU95-20221017152234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002633
Report Date: 10/17/2022
Date Signed: 10/17/2022 03:22:41 PM

Document Has Been Signed on 10/17/2022 03:22 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:	ZHENG, SHI YING		FACILITY NUMBER:	384002633
ADMINISTRATOR:	ZHENG, SHI YING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 601-7480
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94134
CAPACITY:	14	CENSUS: 8	DATE:	10/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:59 PM
MET WITH:	Shi Ying Zheng		TIME COMPLETED:	03:30 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 October 17, 2022 at approximately 12:50 PM Licensing Program Analyst (LPA) Nathan Garcia conducted an unannounced annual inspection. 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 primarily a Chinese Speaker, LPA used some translating applications for assistance.There were 8 children including 3 infants present with the helper, during nap time. Licensee was operating in compliance to the required licensed capacity and ratio limits as of today. Licensee owns this 2 story single family house. The house has 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 area, 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 age-appropriate toys, children's books, and furniture in the day care area. All children’s items were in good condition. There were 2 fully charged 3A40BC fire extinguisher located in the hallways. There were multiple 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. Barricades are 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. Multiple cots and cribs were available for napping. Child proof knobs were installed on the doors to prevent children access to the off-limit areas. There were also exit signs on designated doorways. *Continue to page 2*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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: ZHENG, SHI YING	FACILITY NUMBER: 384002633
	VISIT DATE: 10/17/2022

NARRATIVE

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All posting requirements are met and posted near the childcare entrance. LPA reviewed facility records including all children's files present today. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative. The operation hours are 9:00 AM-5:30PM. Per Licensee, there are no pets, guns or weapons in the home and no open bodies of water or pools. The Licensee provides AM snacks, lunch and early supper for the children.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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 Centers and the ADA, available at: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensees were 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 Licensees. 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. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ZHENG, SHI YING	FACILITY NUMBER: 384002633
	VISIT DATE: 10/17/2022

NARRATIVE

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LPA encouraged the Licensee to visit the Licensing 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.

LPA discussed the safe sleep regulations with 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 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 copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Shi Ying Zheng

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC809 (FAS) - (06/04)

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