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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004001
Report Date: 08/14/2019
Date Signed: 08/14/2019 12:15:46 PM

COMPREHENSIVE INSPECTION
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:KAI MING EARLY HEAD START-BROADWAY CENTER INFFACILITY NUMBER:
384004001
ADMINISTRATOR:CARMEN NGANFACILITY TYPE:
830
ADDRESS:820 BATTERY STREETTELEPHONE:
(415) 982-4570
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94111
CAPACITY:25CENSUS: 21DATE:
08/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carmen NganTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Singh met with director, Carmen Ngan, for a random annual inspection. Purpose of the inspection was explained. This is a combination center. Present, there are 21 children with seven teachers and the director. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday between 8 AM to 4 PM.

With director, LPA inspected the day care areas. LPA observed each room has medical supplies, smoke detector and carbon monoxide detector. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. All toilets, hand washing facilities are in working condition with proper sanitation in place. LPA observed changing table and changing area has proper supplies available and with proper sanitization. All of the milk or formula bottles are stored in the kitchen area. LPA observed all of the bottles has childern’s name labeled. Per director, facility provides the formula and discard the left over food right after feeding. Food preparation area is free of litter. All of the food is stored adequately to prevent any contamination. There is drinking water in play yard for children. Play yard is free of hazards. All of the play structures are steady, in good repair and free of any loose parts. There is sufficient amount of cushion material under the play structures to prevent any fall injuries. LPA observed well maintained sand box in the play yard.

At 10:35 AM, LPA reviewed the facility records. LPA observed that facility is using the electronic sign in / out system. LPA reviewed eight random children's and all present staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Multiple staff members has record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. LPA observed the record of staff’s immunization and competition certificates of mandated reporter training. There are menus posted at least one week in advance and are visible to the child's authorized representative.
See next page for continuation ..........
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: KAI MING EARLY HEAD START-BROADWAY CENTER INF
FACILITY NUMBER: 384004001
VISIT DATE: 08/14/2019
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Facility has record of conducting the fire and emergency drills every month. According to the log, last drill was conducted on July 18, 2019. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2