414001700-3-29-2022-05-CC-ACON-CCYSGP-20220329135216

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001700
Report Date: 03/29/2022
Date Signed: 03/29/2022 01:53:32 PM

Document Has Been Signed on 03/29/2022 01:53 PM - 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:	KHO, MERIAM TUAZON		FACILITY NUMBER:	414001700
ADMINISTRATOR:	KHO, MERIAM T.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 226-3900
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	14	CENSUS: 0	DATE:	03/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Meriam Kho		TIME COMPLETED:	12:15 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	On March 29, 2022 at 9:05 AM, Licensing Program Analyst (LPA) April Cowan conducted an unannounced Annual Inspection, and met with Licensee Meriam Kho. LPA disclosed the purpose of the inspection, and was granted entry into the facility by the Licensee. Present in the facility is Licensee and helper. There are no children in care on this day. Licensee and helper are cleaning the facility. Licensee states that she is closed, and will reopen the facility on April 1, 2022. Facility was inspected and Day-care areas are: living room, dining room, bathroom 1, bedroom 1, lower level of home and backyard. Off Limit areas are: Bedrooms 2 and 3. Facility operates from Monday to Friday, 8:30 AM to 5:00 PM. LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. The living room and family room are set up as classrooms with plenty of learning materials, desks, and toys. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are no bodies of water in the home. There are no poisons, detergents, or cleaning products accessible to day-care children. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires in 7/2023. Licensee conducted last emergency drill on 11/15/21 and is properly logged. Licensee does not provide any meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee has required proof of immunization. >>> See next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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: KHO, MERIAM TUAZON	FACILITY NUMBER: 414001700
	VISIT DATE: 03/29/2022

NARRATIVE

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During inspection,
Precautions for the COVID-19 were discussed. Emergency Evacuations were discussed. Supervision and safety of children were discussed.

At 9:36 AM, LPA reviewed 5 children’s files. LPA observed that children's files are complete with all required Licensing documents. At 9:43 AM, LPA observed that licensee and helper did not have a current Mandated Reporter Training Certificate. A technical Violation is issued this day.

*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)

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
>>> See next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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: KHO, MERIAM TUAZON	FACILITY NUMBER: 414001700
	VISIT DATE: 03/29/2022

NARRATIVE

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Licensee 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Meriam Kho

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

Copy of this report was reviewed and will be emailed to licensee, Meriam Kho, at MERIAMKHO@YAHOO.COM by the close of business on 3/29/22. Confirmation of receipt is required. Signed copy of this report will be stored in the facility file.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC809 (FAS) - (06/04)

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