414001138-7-11-2024-05-CC-CQUO-D73P2G-20240711105556

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001138
Report Date: 07/11/2024
Date Signed: 07/11/2024 10:56:04 AM

Document Has Been Signed on 07/11/2024 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
SAN BRUNO CC RO, 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: 11	DATE:	07/11/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Hye Sook Ji & Grace Chang		TIME COMPLETED:	11:00 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 July 11, 2024 at approximately 8:30am, 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, Grace Chang, and explained the purpose of the visit. Present during LPA's visit included 11 preschool children. Hours of operation are Monday through Friday 8:00am to 6:00pm. Main entrance to the home is through the side door, located on the left side of the home. With licensee, LPA inspected day care areas of the home for health and safety hazards. 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. There are stairs in the home that includes a child, safety gate. Licensee operates home as a Korean immersion program. LPA observed home to be clean, equipped with a variety of toys and materials. Furniture for children was observed to be age appropriate. Flooring in the home includes carpet that was observed to be in good repair, clean and free of stains. LPA observed toys and materials for children's use to be in good condition. Children sleep in the main day care areas on soft, sleeping bags that are stored appropriately. LPA observed electrical outlets to be made inaccessible in day care areas. Home is equipped with a fire extinguisher, fully stocked first aid kit and a smoke/carbon monoxide detector. Bathroom for children's use was observed to be in working condition. LPA did not observe any accessible poisons or cleaning solutions in the day care areas. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JI, HYE SOOK	FACILITY NUMBER: 414001138
	VISIT DATE: 07/11/2024

NARRATIVE

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Entire backyard is fully fenced and enclosed. Outdoor area is equipped with appropriate outdoor toys, materials that are in good condition. There is a play structure in the backyard that includes resilient padding underneath. Flooring in backyard includes artificial turf that is in good condition. There is a storage area in the backyard that is made inaccessible to children. LPA did not observe any pools, spas or bodies of water on site.

Licensee provides a food service that includes two snacks and lunch. Per licensee's assistant, if a child has a food allergy, the food item is not provided to any child present. Isolation area is in licensee's office, separate from other children in care.

LPA observed licensing documents to be properly posted. Licensee maintains a child care roster that was made available for review. LPA reviewed children's records which are complete with emergency information and required immunizations. Licensee's CPR/First Aid certification is current that will expire 12/2024. LPA reminded licensee and facility representative Mandated Reporter certification must be renewed every two years. Per licensee's assistant, there are no weapons or firearms in the home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Facility representative was reminded that all adults 18 and over living or working
in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
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SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JI, HYE SOOK	FACILITY NUMBER: 414001138
	VISIT DATE: 07/11/2024

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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-andresources/safe-sleep as an additional resource. LPA also informed 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Hye Sook Ji, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were issued today during LPA's visit. A notice of site visit was given and must remain posted for 30 days.

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

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC809 (FAS) - (06/04)

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