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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000326
Report Date: 10/18/2019
Date Signed: 10/18/2019 12:54:15 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:VU, GINAFACILITY NUMBER:
414000326
ADMINISTRATOR:VU, GINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 878-4968
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:14CENSUS: 5DATE:
10/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Gina VuTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst,( LPA) Kaur and (LPM) License Program Manager, Ali Zebila conducted an annual random inspection today. LPA met with a licensee, Vu Gina. The purpose of the inspection was explained to licensee. Present at the daycare are licensee, her husband and 5 children (3 infants) and 1(toddler). Licensee lives in the house with her husband. While inspecting the facility with licensee LPA observed children were playing in a group. Licensee husband was helping her by providing care to children. The house has 3 bedrooms, 2 baths, kitchen, dining room, and living room on the upper level; bathroom, living room, garage and backyard on the lower level. The day care areas were: entire lower level and backyard, except garage on the lower level. The house was clean and in order. No change in the daycare areas. Temperature and lighting were adequate. The home is equipped with a fire extinguisher, a smoke detector, and a carbon monoxide detector. There are no bodies of water poisons, and weapons stated by Licensee. Detergents, cleaning products, are not accessible to daycare children. Children toys and equipment are in good condition free of sharp edges and in good repair. Gate was installed at the stairway to upper level to prevent access to the off-limit areas. The outdoor play area was completely fenced. There was a play structure and some ride on toys available for children. Last fire drill was conducted on 09/2019 and is properly logged. Licensee CPR and First aid is expired on 02/2019 . The facility provides snacks to the children. There are 2 pets. Children files and roster were reviewed during visit. LPA also obtained a copy of the roster from licensee during visit. Per licensee, there were no children on special medication. Incidental Medical Services (IMS) policy was discussed. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/. A copy of the AB1207 is on file.
Licensee was informed about the Provider Information Notices (PINs) on CCLD website.
Information regarding 'A Child Care Provider's Guide to Safe Sleep' was provided to the Licensee and is available for review on CCLD website.
Type B deficiency is cited today.....
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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: VU, GINA
FACILITY NUMBER: 414000326
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2019
Section Cited

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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation
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pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

LPA observed CPR/First Aid Expired on 02/2019
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2019
LIC809 (FAS) - (06/04)
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