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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002639
Report Date: 09/05/2019
Date Signed: 09/05/2019 04:43:41 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:ZHEN, XIAO XIA & ZHU, LISAFACILITY NUMBER:
384002639
ADMINISTRATOR:ZHEN, X. & ZHU, L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 509-6540
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:14CENSUS: 11DATE:
09/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Xiao Xia ZhenTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with a licensee, Xiao Xia Zhen, and her helper who has fingerprint clearance. The purpose of the inspection was explained to her. There were 11 children included 2 infants with a helper present. The mother of a child who showed up at the facility upon LPA arrival. According to the licensee, the mother tried to spend more time with the child because her child was new to the daycare. Licensee, Xiao Xia Zhen rents an in-law with a backyard in 2 stories single-family house. Licensee lives in the in-law with her husband. Licensee’s daughter and co-licensee (Lisa Zhu) rent the rooms with other roommates on the upper level. All adults are fingerprinted and associated with the facility. LPA toured and inspected the facility for health and safety hazard. The facility was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were either locked or made inaccessible to children. The daycare areas are the entire lower level, & backyard except licensee’s bedroom, a garage & a hallway. Off-limit areas are entire upper level, licensee’s bedroom on the lower level, garage, hallway on the lower level, and a storage room in the backyard. Licensee installed soft cushioning to the entire floor to prevent injury. Licensee also installed a Surveillance system in the daycare for security purpose. All electrical outlets were covered. There were plenty of age-appropriate toys, books, play structure, learning material, and children’s furniture. They were in condition and repair. Cots were used for napping. Cubbies were available for children to store their belongings by the entrance. There was a fully charged 2A10BC fire extinguisher, a working telephone, and first aid supplies available in the daycare. The smoke and carbon monoxide detectors weren’t tested due to children were napping during the inspection. Per licensee, there were no guns, no weapons, and no pets in the house. Children’s bathroom was clean and free of harmful objects. The lower bathroom cabinet was latched. Childproof knobs were used at the doors to prevent children access to the off-limit areas. Licensee provides breakfast, AM/PM snacks, lunch and dinner to daycare children. The outdoor play yard was completely fenced. It was clean and in order. There were plenty of age-appropriate toys, a play structure with soft cushioning underneath to prevent injury, and ride-on toys available for children. Turf and rubber mats were installed to the entire playground as the soft cushioning to prevent injury. Gate was used at the stairway in the yard. Licensee and helpers had current CPR/First Aid training; they will expire in 5/2021. Per licensee, there were no children on special medication. 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 the 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 the visit. LPA obtained a copy of the roster from licensee during the inspection. Licensee and her helper had required immunization. Licensee and helper also completed the Mandated Reporter Training (AB1207). The records and certificates were reviewed during the inspection.
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 inspection. Notice of site visit was provided. 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: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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