414001138-2-10-2023-05-CC-CQUO-CNWQ83-20230210105604

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001138
Report Date: 02/10/2023
Date Signed: 02/10/2023 10:56:37 AM

Document Has Been Signed on 02/10/2023 10:56 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	JI, HYE SOOK		FACILITY NUMBER:	414001138
ADMINISTRATOR:	JI, HYE SOOK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 515-6812
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	14	CENSUS: 12	DATE:	02/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Hye Sook Ji & Grace Chang		TIME COMPLETED:	11:15 AM

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	On February 10, 2023 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Hye Sook "Hannah" Ji, and licensee's adult daughter/assistant and explained the purpose of the inspection. Present during LPA's visit included 12 enrolled children (all preschool age). Licensee is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have criminal record clearance on file. Hours of operation are Monday to Friday 8:00am to 6:00pm. Licensee lives in the home with their spouse. The home is a multi-level, single family home. Entrance to the day care is through side door located on left side of home. The DAY CARE AREAS are located on the ground level of the home only, which includes 2 playrooms (main classrooms), bathroom #1, office (located next to bathroom), and portion of the backyard. The OFF LIMIT AREAS are the garage (pass by only), portion of the backyard and entire second level of home. Off limit areas are made inaccessible with child safety gates. LPA toured day care areas of home with licensee's assistant. LPA observed the home to be in good repair with proper temperature and ventilation. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers. Home is equipped with a variety of age appropriate toys and equipment that were in good working condition. Cleaning supplies, poisons and other chemicals were stored inaccessible in home's high shelves. Accessible cabinets were not observed to have any hazards or poisons. There is sufficient storage for children's belongings inside the home. Bathroom was observed to be in proper working condition with appropriate sanitation products and toileting equipment. Home is equipped with a working smoke and carbon monoxide detector, fully charged fire extinguisher ,fully stocked first aid kit and a working phone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JI, HYE SOOK	FACILITY NUMBER: 414001138
	VISIT DATE: 02/10/2023

NARRATIVE

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The entire backyard is enclosed with an at least 5 ft. high fence. There is separation between area of where children are allowed to play and children are not to access with a fence. Backyard is equipped with sufficient toys and equipment that were age appropriate. There is a play structure in backyard that was observed to have resilient padding underneath with mats and turf. LPA did not observe any spas, pools, or bodies of water on site.

LPA reviewed five children's records which were complete. Children's files have a record of emergency identification information on file. Licensee has a valid and current CPR certification that will expire 12/2024.

Last emergency disaster drill was conducted 01/10/2023 . Emergency drills are conducted at least once every six months and are properly logged. Licensing documents are properly posted and made available for review inside main classroom.

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: www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Facility Representative was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JI, HYE SOOK	FACILITY NUMBER: 414001138
	VISIT DATE: 02/10/2023

NARRATIVE

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LPA discussed the safe sleep regulations with facility representative 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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Due to no ink on LPA's portable printer, LPA was unable to provide a hard copy of report during visit. LPA to email copy of report to email address on file. Acknowledgement of receipt of report is required.

Exit interview conducted and report was reviewed with facility representative, Grace Chang.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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