414004729-10-2-2020-05-CC-ACON-BTZSQK-20201002140452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004729
Report Date: 10/02/2020
Date Signed: 10/02/2020 02:06:18 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:	CHOY, RUTH H.		FACILITY NUMBER:	414004729
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/02/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Ruth Choy		TIME COMPLETED:	02:15 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	Licensing Program Analyst (LPA) April Cowan conducted a pre-licensing inspection today. Due to Covid-19, the Inspection was conducted via Zoom. The applicant is applying for a small family childcare license. Applicant lives in a single family five bedroom and three bathroom home. Present in the home today with the applicant is spouse, applicant's sister-in-law, and three minor children. Applicant lives in the home with husband and three minor children. A review of records indicates that all adults living in the home who require caregiver background checks have received criminal record and child abuse index clearances. Childcare areas are the lower level bedroom 3, family room, bathroom 3, and lower level back yard. The rest of the home is off limits to children in care. Applicant owns home, possess proof of control of property, and states that this is their primary residence where they live full time. The day-care will operate Monday through Friday, 7:00 am - 6:00 PM. Applicant states that they understand that they are the primary person responsible for operating and providing care and supervision to the children, regardless if the applicant hires helpers or assistants to work with them. Applicant understands that they may only be absent from the home no more than twenty percent of operating hours. During the twenty percent absence applicant understands that they may designate another person to provide care and supervision to the children who is qualified with Mandated Reporter Training, Pediatric CPR and First Aid Training, has obtained criminal record clearances, child abuse index checks, a TB test with results, immunizations as required by law, and has a signed Criminal Record Statement and Acknowledgement to Report Suspected Child Abuse forms. Report continues....

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: CHOY, RUTH H.	FACILITY NUMBER: 414004729
	VISIT DATE: 10/02/2020

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
26
27
28
29
30
31
32

Page 2
Capacity and ratio options were reviewed with the applicant today. Applicant understands that care cannot be provided for more than the capacity as stated on the license. Applicant understands that their own children under the age of ten will count in the day-care ratio. Applicant is aware to inform parent of the two additional children (6 years plus in age and one of the two children can count if they are enrolled in Kindergarten) and must also notify the parents if care is being provided to the two additional children. Applicant will require parent’s sign the affidavit for liability insurance or obtain adequate liability insurance.

During today’s inspection, LPA toured the home and yard. LPA observed the following today: 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. There are no bodies of water on the property. There is a fireplace that is not in the day-care area. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Applicant states there are no guns or weapons of any kind in the home. The yard is fenced (Applicant must be directly present with children any time they are outside). There are no pets in the home.

Care and Supervision and transportation of children was discussed. Visitors to the home was discussed. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. Isolation of sick children was discussed. Discipline used will be redirection.

LPA reviewed the required day-care forms with applicant. Records for Children and staff/helper files were reviewed. Required Postings were discussed. All required postings are properly posted. Applicant understands emergency drills must be conducted at least once every six months and properly logged. Children’s Roster was reviewed and will be maintained as required.
Applicant has updated immunizations and Mandated Reporter Training on file. Applicant’s CPR and First Aid expires 9/12/22. Applicant has completed 16 hours preventative health practices training.
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
Report Continues...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CHOY, RUTH H.	FACILITY NUMBER: 414004729
	VISIT DATE: 10/02/2020

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
26
27
28
29
30
31
32

Page 3

Applicant was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

Applicant was informed about the Provider Information Notices (PINs) on CCLD website.

Applicant was reminded about Mandated Reporter Training available on CCLD website. Training is valid for two years.
(www.ccld.ca.gov or www.mandatedreporterca.com)

Applicant was advised of ‘Safe Sleep” and provided with handouts regarding “safe to sleep “ best practices.

A Covid-19 RAST Inspection was completed this date.

The following corrections will be necessary before a license to operate a small family child care license can be recommended:
- Locks to 2 doors that lead from the family room to the garage
- barricade upper level backyard from lower level back yard
- purchase girl toys
- applicant will submit remaining FCCH documents

This report and appeal were discussed with Applicant. This report is emailed to applicant, and applicant agrees to reply for confirmation of receipt.
For additional questions please call: San Bruno Child Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or the Centralized Complaint and Information Bureau at 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3