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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004119
Report Date: 08/12/2019
Date Signed: 08/12/2019 03:39:34 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:SHEN, YUNHANFACILITY NUMBER:
414004119
ADMINISTRATOR:SHEN, YUNHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 928-4112
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:14CENSUS: 9DATE:
08/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Yunhan Shen, WeiXuan ZhengTIME COMPLETED:
04:00 PM
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2, Licensing Program Analyst (LPA), Yee conducted an annual random inspection today. I met with two helpers and 9 napping children. One hour later, Licensee, Yunhan Shen arrived at the facility. The facility personnel summary report was reviewed with Ms. Shen and she said it's current. Current residents are Licensee, Yunhan Shen, her husband, their 3 years old child, and one tenant. Daycare areas are main level: Living Room, Kitchen, Bedroom #2 for napping, and Bathroom #1. Off Limit Areas are the main level: Bedroom #1, #3, Deck, lower level: Garage, Family Room, Garage, Bedroom #4, Backyard, and Front yard. All off-limit areas are properly barricaded. LPA observed the deck is set up with a play structure, licensee said she does not use the deck. The deck is off-limit. The play structure is for her child. The home is equipped with a smoke detector, carbon monoxide detector, and a fire extinguisher. The home is ventilated properly. Licensee’s CPR expires in 6/17/21. The facility provides snacks and lunches. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Child Abuse Mandated Reporter Training, AB1207. https://www.mandatedreporterca.com/
All staffs have AB1207 on file. Required immunization for staffs is on file. The roster was not available. LPA provided a blank form today. SIDS " A Child Care Provider's Guide to Safe Sleep" was explained and provided.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
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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