384004403-4-26-2022-05-CC-HRCO-CDUM8M-20220426092320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004403
Report Date: 04/19/2022
Date Signed: 04/26/2022 09:23:27 AM

Document Has Been Signed on 04/26/2022 09:23 AM - 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:	KAI MING MISSION BAY CHILDREN'S CENTER		FACILITY NUMBER:	384004403
ADMINISTRATOR:	LEUNG, SUSANNA		FACILITY TYPE:	830
ADDRESS:	671 CHINA BASIN STREET		TELEPHONE:	(415) 982-4777
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94158
CAPACITY:	25	CENSUS: 0	DATE:	04/19/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Susanna Leung, Cindy Mach, Gabriela Rivera		TIME COMPLETED:	12:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Haydee Caliboso met with applicants Susanna Leung (Facility Manager/Regional Manager), Gabriela Rivera (Regional Manager) and Cindy Mach (Site Manager) today for a pre-licensing inspection. The applicant has requested a combination of an infant with toddler component program. The applicant has requested 9 infants, ages birth to 18 months, and 16 toddlers, ages 18 months to 36 months. The facility plans to operate Monday - Friday; 7:00AM to 6:00PM. The designated Site Manager for the facility will be Cindy Mach. The facility was inspected today, indoor and outdoor, for health and safety hazards, and was measured to calculate capacity. This inspection included a technical assistance inspection for COVID-19 guidance and support. Indoor: The facility building that will be used for the program is on the lower level of a residential building. The facility building has its own designated entrance. The facility has a designated “Playroom area” located in the main entrance and was calculated for 683.20 sq. ft, allowing for a capacity of 19 children. The “Playroom area” was observed to be clean and safe. There is one designated classroom for the infant program and one classroom for the toddler program. The infant classroom was calculated to be a total of 426.76 sq. ft., allowing for a capacity of 9 infants. Toddler classroom was calculated to be 817.37 sq. ft., allowing for a capacity of 16 toddlers. The classrooms are observed today to be clean and equipped with a fire extinguisher, and both smoke and carbon monoxide detectors. The facility is adequately ventilated and free of insects and bugs. The classrooms and furniture equipment are clean and in good condition. Children’s toys and supplies are orderly, in good condition, and age appropriate. There is storage space for children's personal belongings. Each classroom has a built-in counter-top area, sinks available for staff and children to use, and garbage cans with tight-fitting lids. The facility has a first aid kit in each classroom and a designated backpack with emergency supplies. Cont. 809-C pg. 2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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: KAI MING MISSION BAY CHILDREN'S CENTER	FACILITY NUMBER: 384004403
	VISIT DATE: 04/19/2022

NARRATIVE

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Refrigerated medications will be stored separately from food. Medication will be administered with parental consent and will be kept in the child’s file for record. All medication will be logged when administered to children. The facility has a designated kitchen area where food is prepared, a working refrigerator, and a working dishwasher where utensils are to be cleaned. The program will provide morning and afternoon snacks, and lunch daily. The program will provide a sheet and blanket for the children. Bedding is to be washed twice per week or as needed. Cots will be used for older infants and will be cleaned daily or as needed. The toddler classroom has 2 toilets and 2 sinks available for children to use. The bathroom was observed to be clean and with no health or safety hazards.

Infant: There is storage for infants’ personal belongings. The program will provide diapers and wipes for the infant. The program will also provide bottles/nipples and any other food service items for each infant, and the staff will ensure breastmilk and or milk formula is served fresh daily to the infant. The infant classroom has a built-in counter-top area, with a sink which includes bottle warmers and a refrigerator. The bottle warmer is out of reach of the children. There are 6 cribs available for infant to use. Regional Manager and Site Manager stated, additional cribs will be purchased as enrollment increases. Drinking water for the children will be provided by plastic baby water bottles or cups with lids provided by the program. Medications for infants will be stored in the classroom in high cabinets or in locked boxes in the refrigerator. All furnishings and equipment are observed to be safe, in good condition, and age appropriate. The diaper changing table area has a sink within arm’s reach. Staff will meet and review the individual written needs and service plans quarterly with the parents. Plans will be kept in the children’s files.

There are 2 separate restrooms available for staff to use. The isolation area for ill children is located at the site supervisor’s office. Staff bathrooms will be used for ill children, if needed, until parents arrive for pick-up. Children in the program will be signed in and out daily by parents using an electronic signature. The facility will conduct and log fire drills once every six months, and the log will be available upon request. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children.
Cont. 809-C pg. 3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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: KAI MING MISSION BAY CHILDREN'S CENTER	FACILITY NUMBER: 384004403
	VISIT DATE: 04/19/2022

NARRATIVE

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Outdoor: The outdoor area measures a total of 1,980 sq. ft., allowing for a total of 26 children. The program provided a request waiver for scheduled outdoor rotation usage. The facility’s outdoor playground is enclosed and gated with a fence approximately 10 ft. tall. The outdoor space was observed to be clean, safe, and equipped with toys that are age-appropriate for children. The outdoor space playground has pea gravel for cushion. Sandbox will be inspected daily and kept free of hazardous materials. Additionally, the program will provide water for outdoor time.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicants 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 [applicant, licensee, or 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
Cont. 809-C pg. 4

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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: KAI MING MISSION BAY CHILDREN'S CENTER	FACILITY NUMBER: 384004403
	VISIT DATE: 04/19/2022

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Susanna Leung. An electronic copy of this 4 page report was emailed to Susanna Leung. Applicant was asked to review the report and return a signed copy of the report to LPA Haydee Caliboso.

Based on available square footage, sinks, and toilets, LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 25 children. The following is required prior to licensure:

· Obtain fire clearance from SF Fire Department.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC809 (FAS) - (06/04)

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