414004602-8-28-2020-05-CC-WLYY-BSWKHS-20200828075535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004602
Report Date: 08/27/2020
Date Signed: 08/28/2020 07:56:04 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:	YEN, LING K.		FACILITY NUMBER:	414004602
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	08/27/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ling Yen		TIME COMPLETED:	03:00 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	Due to COVID-19 and DPH guidelines of social distancing, Licensing Program Analyst (LPA) Winnie Ly conducted the Increase of Capacity and Technical Assistance tele-inspections via FaceTime on August 27, 2020 at 1:00pm with Licensee Ling Yen. Present at the family child care during the tele-inspections were licensee, helper and five children. Licensee owns this three story home and resides on premises with her husband and two minor children. The first floor consists of one bedroom, a family room and kitchenette which is being rented out to a tenant. The second floor consists of two bedrooms, living room, dining room, kitchen, a bathroom, and a backyard. There is a master bedroom on the third floor. All adults in the home have criminal record clearance. The family day care is on the second floor consists of living room, two bedrooms, dining room , kitchen, a bathroom and backyard. The off limit areas are the entire first floor where tenant occupied, the master bedroom on third floor and the garage. Facility has fire clearance approved and on file. Per licensee, family child care’s operating hours are from Monday-Friday 8:30am-5:30pm. During the tele-inspections, the home is clean, safe, and has working smoke detector, carbon monoxide detector, fire extinguisher, and telephone. Licensee has a first aid kit and a thermometer. There are no bodies of water on the premises. Home has age appropriate toys and equipment available for the children in care. Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care. Those items shall be made inaccessible to children. Discipline policy was discussed with applicant. Per Licensee, home does not have firearms or dangerous weapons. Continue>>>

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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: YEN, LING K.	FACILITY NUMBER: 414004602
	VISIT DATE: 08/27/2020

NARRATIVE

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Licensee is also been advised all adults, 18 years and older living in the home, helper, or assistant must have criminal background clearance and must be associated to the facility by submitting an LIC 9182 with copy Ca. ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 also informed 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.

LPA discussed Child Abuse Mandated Training AB1207 with Licensee. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Licensee was also advised to reach out to San Bruno Regional Office for concern or questions. Desk Duty is available M-F, 8a.m.-5p.m. (650) 266-8800. Website for forms and regulations updates: www.cdss.cs.gov/inforesources/Community-Care-Licensing

A copy of this report will be email to applicant. Applicant was advised to acknowledge receipt of report once received.

Prior to Licensure: Applicant needs to send acknowledgement of receipt of Pre-Licensing report to LPA.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC809 (FAS) - (06/04)

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