414004693-8-13-2021-05-CC-CQUO-C5UUVT-20210813155537

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004693
Report Date: 08/13/2021
Date Signed: 08/13/2021 03:56:07 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:	KUO, WAN YU		FACILITY NUMBER:	414004693
ADMINISTRATOR:	KUO, WAN YU		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 380-8555
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 10	DATE:	08/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee, Wan Yu Kuo		TIME COMPLETED:	03:15 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 13, 2021 at 1:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual required inspection. LPA met with licensee, Wan Yu “Alice” Kuo and explained the purpose of the inspection. Present in home were the licensee, licensee's helper, licensee’s minor child and 9 enrolled children (2 infants and 7 preschoolers). Licensee is operating within capacity requirements on this day. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00am to 6:00pm. LPA and licensee conducted health and safety inspection inside and outside the home. The licensee is licensed for large Family Child Care Home. The home consists of 3 bedrooms, 2 bathrooms, 2 living rooms (1 in front of the home and 1 in the back of the home), dining area (office), kitchen, backyard, and garage. All guests enter home through gate on side of the house. The DAY CARE AREAS are the living room (located in the back of the home), bathroom #1, and backyard. The OFF-LIMITS AREAS are living room (located in front of the home), all bedrooms, dining room, kitchen, and garage. All off limits areas are made inaccessible to children by child safety gates and/or child proof locked door knobs. At 1:40pm, LPA toured day care areas of home with licensee. 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. Home does not have a fireplace or bodies of water. Outdoor toys and equipment were age appropriate and in good working 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: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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: KUO, WAN YU	FACILITY NUMBER: 414004693
	VISIT DATE: 08/13/2021

NARRATIVE

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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 her cellphone. Licensee is aware phone has to be within the home during all hours of operations. Per Licensee, there are no weapons or firearms in the home. Licensee has 2 cats in the OFF-LIMITS area of the home, completely separated from day care areas. LPA reviewed two children’s records. Children’s records have a record of emergency identification information on file. Licensee’s Pediatric First Aid/CPR is current and will expire 07/2022. Last emergency drill was conducted in 06/2021. Emergency drills are conducted at least once every six months and are properly logged. LPA reviewed documented safe sleep log for infant children in care. Safe sleep logs are properly documented.

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 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 Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.
-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. This report was reviewed and discussed with Licensee, Wan Yu “Alice” Kuo. No deficiencies were cited today.

This report is public and can be reviewed. A copy of report and Notice of Site Visit was emailed to licensee at kalice2@gmail.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: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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