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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002668
Report Date: 12/12/2019
Date Signed: 12/12/2019 04:33:35 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:LI, MEI JUANFACILITY NUMBER:
384002668
ADMINISTRATOR:LI, MEI JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 841-1138
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:14CENSUS: 8DATE:
12/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Mei Juan LiTIME COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted unannounced increased inspection today. LPA met with the licensee, Mei Juan Li, and her helper who has fingerprint clearance. Licensee is a Primary Chinese Speaker. The purpose of the inspection was explained to them. There were 8 children included 2 infants with a helper present. The children were napping upon LPA arrival. Licensee's daughter and Son-In-Law owned this single family house. Licensee lived in this house with her granddaughter who was minor. The house has 3 bedrooms, 2 bath, living room, dining room, and an open kitchen on the upper level. The lower level has a play room, 1 bathroom, garage, and backyard with patio. The day care areas are entire lower level except garage, & backyard with Patio. The off-limit areas were: entire upper level, kitchen area in the play room down stair, & garage. 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 the children. There were plenty of the age-appropriate toys, books, learning material and children’s furniture available for children. All electrical outlet were covered. There were the fully charged 2A10BC fire extinguisher, working telephone, and first aid supplies. The smoke and carbon monoxide detectors were not tested due to napping. The children bathroom was clean and free of harmful objects. Licensee provides breakfast, AM/PM snacks, lunch and dinner to the day care children. The outdoor play yard was completely fenced. Gates were installed at the stairway. Soft cushioning was installed to the entire play ground to prevent injury. There was the 4 ft fence installed at the patio. Gate was installed at the main day care entrance. Cribs and cots were used for napping. Per licensee’s, 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 publication: Commonly Asked Questions about Child Care facilities and the ADA, available at: http://www.ada.gov/childqanda.htmLicensee had current CPR/First Aid training certificate for review; it will expire in 10/2021. Disaster drill has been conducting monthly. The latest drill was conducted on 11/2019. All the required postings were posted. Children files and roster were reviewed during the inspection. LPA also obtained a copy of the roster from licensee during the inspection.

This report and notice of site visit were discussed with the licensee in Chinese 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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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