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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004292
Report Date: 02/07/2020
Date Signed: 02/07/2020 11:22:18 AM

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:LIU, RACHEL C.FACILITY NUMBER:
414004292
ADMINISTRATOR:LIU, RACHEL C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 623-8933
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:14CENSUS: 5DATE:
02/07/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Liu Racheal C.TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Saini conducted an unannounced required one year inspection today. LPA met with licensee Liu, Rachel C. Purpose of the inspection was explained. Present Licensee and her helper taking care of 5 children ( 2 infants and 3 preschoolers) including licensee’s (3.5 years) old daughter.

At 8:40am LPA and Licensee inspected the day care area for health and safety hazards. Adults living in the home are licensee and her 3 minor daughters. Licensee owns this single family home. Day care area: Living room, Dining Area, Deck, Bathroom #1, Bedroom #3, portion of the Backyard. Off Limit areas are: Kitchen area, Bedroom #1 and Bedroom #2 with Bathroom #2, Garage, portion of the Backyard. All off limit areas are properly barricaded. The home has smoke detectors, a carbon monoxide detector, a working telephone , and a fully charged 2A10BC fire extinguisher. Home has a current first aid kit. Per Licensee, there are no firearms or weapons in the home. There are no bodies of water on the property. The bathroom is clean and free of hazards. All electrical outlets are covered. There is a variety of age appropriate toys in the home. Licensee provides daily snacks and meals. All required postings are properly posted. The Outdoor play area is completely fenced. There are verity of age appropriate outdoor toys available for children such as ride on the toys, slides and etc.

At 9:15 LPA reviewed children's files. Children's files contained all the required documents.

At 9:35 LPA reviewed licnesee's and helper's files. Licensee has the CPR and First Aid training valid until 10.06.20. Licensee has a proof of immunity of Measles, pertussis and Influenza. Helpers' immunization is not available in the file to review. LPA advised licensee to keep helpers immunization on file. Licensee has completed mandated reporter training and certificate is on the file However, helpers AB1207 is not on the file to review.

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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: LIU, RACHEL C.
FACILITY NUMBER: 414004292
VISIT DATE: 02/07/2020
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Licensee has log for each drill being conducted. Fire drill log is posted next to the facility license. Per licensee’s log, last drill was conducted on 02.01.20. Licensee presented a current roster of children in the facility which is complete and up to the date.

LPA discussed IMS with the licensee. Per licensee, no children need IMS in her daycare.

LPA reminds the Licensee 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.



Safe Sleep Regulation, Safe Sleep Environment, Items not permitted in a home and SIDS handouts were provided to the Licensee.

LPA encourage the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.


>No deficiencies were cited today under Title 22 Division 12 of the California 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 shall be posted for 30 days from today's visit.
Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
LIC809 (FAS) - (06/04)
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