414002385-8-1-2019-05-CC-GASL-BEMSYR-20190801141759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002385
Report Date: 08/01/2019
Date Signed: 08/01/2019 02:18:05 PM

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:	YANG, MARICHU KHO		FACILITY NUMBER:	414002385
ADMINISTRATOR:	YANG, MARICHU KHO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 832-1558
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY:	14	CENSUS: 3	DATE:	08/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Marichu Kho		TIME COMPLETED:	02:30 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	Licensing Program Analyst (LPA) Glenn Schnell conducted an annual random inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee today. Present in the home is Licensee, Marichu and her husband and helper. Capacity and ratio requirements of children was observed in compliance today. This type of home is a single family home. Off limit rooms were identified as one bedroom, a bathroom and a garage. Adults living in the home are Marichu, Angelito and Meryll . A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee owns home. The day-care operates 8 AM to 6 PM , Monday through Friday. Licensee has day-care insurance through Farmers. LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property. There fireplace in blocked. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard, which is a deck, is fenced. Licensee states there are no pets in the home. Licensee’s CPR and First Aid are current. Emergency drills are conducted at least once every six months and properly logged. Parents provide daily snacks and meals.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

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: YANG, MARICHU KHO	FACILITY NUMBER: 414002385
	VISIT DATE: 08/01/2019

NARRATIVE

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Discipline used is time-out. Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up-to-date. Children and staff/helper files were reviewed and are complete. Supervision and transportation of children was discussed. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist) Licensee has updated immunization's and Mandated Reporter Training on file. 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

Licensee was reminded 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.

Licensee was informed 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). Licensee was advised of the upcoming changes to regulations regarding ‘Safe Sleep” and provided with handouts regarding “safe to sleep “ best practices.
No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.
This report and appeal rights were discussed with Licensee. This report must be available in the facility for public review. Notice of Site Visit was posted. Notice to remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

LIC809 (FAS) - (06/04)

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