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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002833
Report Date: 02/16/2022
Date Signed: 02/16/2022 01:30:39 PM


Document Has Been Signed on 02/16/2022 01:30 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:NGTSANG, SHIU KUEN & TSANG, CHO YFACILITY NUMBER:
384002833
ADMINISTRATOR:NGTSANG, SHIU KUENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 309-8532
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 10DATE:
02/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ngtsang, Shiu Kuen & Tsang, ChoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst, LPA Yee conducted a Required - 1 year inspection today. The purpose of the inspection was explained. Present at the facility are licensee, co-licensee, 2 helpers and 10 children. Current residents at the facility are licensee and co-licensee only. The facility personnel summary report was reviewed with Barbara and she said it's current. Day-care areas (lower level): large living room, a bedroom located in the back, middle room and backyard. The entire upper level is off-limit. The home is ventilated properly. The home is equipped with a smoke detector, a carbon monoxide detector, and a fully charged fire extinguisher. The last emergency drill was conducted on 1/18/22. A log sheet was reviewed. CPR & 1st aid are current until 9/5/2022 . The facility provides meals for the children. A written IMS plan is on file. Child Abuse Mandated Reporter Training, AB1207 certificate is on file. Licensee, co-licensee, helpers completed on 4/3/2021. LPA reminded the licensee that the training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. www.mandatedreporterca.com. Liability insurance is on file. 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 licensee [facility representative] 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.

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: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2022
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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