414002226-8-25-2021-05-CC-CQUO-C68S3G-20210825133104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002226
Report Date: 08/25/2021
Date Signed: 08/25/2021 01:32:02 PM

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:	DONG, KUMARI & TAMANG, PREM B.		FACILITY NUMBER:	414002226
ADMINISTRATOR:	DONG, KUMARI & TAMANG, PRE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 312-8504
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 4	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Kumari Dong & Prem Tamang		TIME COMPLETED:	01:00 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 August 25, 2021 at 10:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with both licensees, Kumari Dong and Prem Tamang, and licensee’s helper (H1). Purpose of visit was explained to licensees and H1. All adults living or working in the home have criminal record clearance on file. At the time of inspection, present in the home were both licensees, H1, licensee’s adult son, and 2 infants. Facility is operating within capacity requirements on this day. LPA and licensees conducted a health and safety inspection inside the home. The licensees are licensed for a Large Family Child Care home. Hours of operation are Monday to Friday from 7:00am to 6:00pm. LPA inspected day care areas of the home. The DAY CARE AREAS are the living room, kitchen, dining area, bedroom #1, bedroom #2, bedroom #3, bathroom #1, and backyard. The OFF-LIMITS AREAS are bedroom #4 (located on first floor), entire upstairs of home, and garage. OFF-LIMIT AREAS are made inaccessible to children by locked doors and child safety gates. At 11:15am, additional infant arrived at facility. Present during inspection were both licensees, H1, licensee’s adult son, and 3 infants. LPA observed home to be in good repair with proper temperature and ventilation. There were a variety of age appropriate toys and equipment in the home which are in good condition. (Continue on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: DONG, KUMARI & TAMANG, PREM B.	FACILITY NUMBER: 414002226
	VISIT DATE: 08/25/2021

NARRATIVE

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Home contains a fireplace and is barricaded by furniture and soft cushioning. Outdoor space is equipped with age appropriate toys that are in good working condition. Backyard is fenced with an least 4 foot high fence. Backyard floor contains soft cushioning for crawling infants.

All cleaning supplies, poisons and other chemicals were stored inaccessible to children. There was a working carbon monoxide detector and a fully charged fire extinguisher. Phone number listed for licensee is up to date. Primary contact is through licensee’s mobile number. Accessible electrical outlets are updated, renovated child proof outlets.

LPA reviewed facility’s roster on file and two children’s records. Children’s records are complete and have a record of emergency identification information on file. Both licensees' Pediatric First Aid/CPR is current and will expire 3/2023. Last emergency drill was conducted June 1, 2021.

Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time. 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 Americans with Disabilities Act (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.

During inspection:
-Licensee was reminded all available licensing documents must be posted in a prominent place for families to view.
-Licensee was reminded as of January 1, 2018, all staff are required to complete Mandated Reporter training and must be renewed every 2 years. This training can be obtained online at www.mandatedreporterca.com

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: DONG, KUMARI & TAMANG, PREM B.	FACILITY NUMBER: 414002226
	VISIT DATE: 08/25/2021

NARRATIVE

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During Inspection:
-Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation, CA DPH Guidance for use of face coverings, receiving important updates and lead poisoning facts flyer.
-Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
-Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
-Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

After today’s inspection, an exit interview was conducted with licensee, Kumari Dong. This report was reviewed and discussed. This report is public and can be reviewed. No deficiencies were cited today.

A copy of report and Notice of Site Visit was emailed to licensee at milan94@yahoo.com. Licensee was reminded that a site notice shall be posted in a prominent place in facility for 30 days during the hours of operation. Failure to maintain postings as required will result in a civil penalty of $100.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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