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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002986
Report Date: 12/29/2022
Date Signed: 12/29/2022 01:32:58 PM


Document Has Been Signed on 12/29/2022 01:32 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:YE, PEIYIFACILITY NUMBER:
384002986
ADMINISTRATOR:YE, PEIYIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 298-6636
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 3DATE:
12/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Peiyi YeTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Yee conducted an Unannounced Required - 1 Year inspection to this family child care home today. Present at the facility are the Licensee, Peiyi, mother in law, 1 helper. The purpose of the inspection was explained. The facility personnel summary report was reviewed with Peiyi and she said it's correct. Current residents are licensee, Peiyi, her husband, mother in law, father in law, and their 8 year old child. The facility operation hours are Monday - Friday, 8:00 am - 6:00 pm.

Daycare areas are (upper level): Living room, dining room, kitchen, hallway bathroom, patio and backyard (backyard was inspected today and approved). The remaining areas of the home are off-limits.

The home is clean orderly and properly ventilated. The home is equipped with a fully charged fire extinguisher size 2A10BC, a smoke detectors, and a carbon monoxide. Smoke detector and carbon monoxide are in working condition. There are no bodies of water in the premises. All harmful objects such as sharp, chemicals, detergents, cleaning compounds, medication are made inaccessible to children in care. Kitchen/Bathroom cabinets/drawers have child protective locks in place making all sharp objects or toxic household items inaccessible to children. First aid supplies are available for children. The facility conducts fire drills/earthquake drills and was properly logged (10/11/2022). The disciplinary policy was discussed with Licensee today. The home has age-appropriate toys and equipment available for the children in care.

LPA reviewed the children's roster and staff records during the visit. Staff records are in order.

continue to the next page.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022
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: YE, PEIYI
FACILITY NUMBER: 384002986
VISIT DATE: 12/29/2022
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Licensee’s CPR and 1st aid certificate is current and will expire on 7-10-2023.

LPA discussed Child Abuse Mandated Reporter Training AB1207 with Licensee. As of January 1, 2018, all staff will be required to complete Child Abuse Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. The licensee completed AB1207 on 05/01/2021.

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 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.

Notice of Site Visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2