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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001138
Report Date: 02/14/2020
Date Signed: 02/14/2020 09:42:52 AM

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:JI, HYE SOOKFACILITY NUMBER:
414001138
ADMINISTRATOR:JI, HYE SOOKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 992-4245
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:14CENSUS: 6DATE:
02/14/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Hye JiTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Kaur, met with licensee, Ji Hye Sook, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a double-story home. Present, there are 6 children in care with licensee and her husband. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date.
LPA inspected the day care areas with the licensee. At 08:05 LPA inspected day care area while touring facility LPA observed children were playing in a group. Day Care Area is entire Lower level and backyard except garage. Off limit area is upper level. There is gate installed to prevent access to go on upper level. There is no pool, spa or any other body of water in the house. There is no fireplace in the day care areas. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. LPA inspected the playyard, there are plenty of toys for children to play in the play yard. There is a variety of age appropriate toys in the house. Per licensee, there are no firearms or weapons in the house. Licensee provide snacks and lunch to children. There is small fish tank in facility.
At 8:45 AM, LPA review the children's record. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee’s CPR will expire on September 2020. LPA remind the licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. Per licensee’s log, last drill was conducted in December 2020.
LPA informs the licensee that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Immunization records were checked during previous inspection.
LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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. SIDS information was provided.No deficiencies were cited on this day.Copy of this report was provided and reviewed by the licensee. The notice of site visit was posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
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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