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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004729
Report Date: 09/17/2021
Date Signed: 09/17/2021 05:27:25 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:CHOY, RUTH H.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 315-6825
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:14CENSUS: 6DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ruth ChoyTIME COMPLETED:
11:55 AM
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On September 17, 2001 at 09:20 AM, Licensing Program Analyst (LPA) April Cowan conducted an unannounced Required 1 - Year Inspection and met with Licensee. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Present in the facility is Licensee, helper, Karen Huang, caring for 6 children (3 infants and 3 preschool age). Licensee's spouse is home in an off-limits area. All adults present have Fingerprint Clearance. Licensee lives in a 5 bedroom, 3 bathroom home. Licensee lives in the home with spouse and three minor children. Facility was inspected and Day-care areas: lower level bedroom 3, family room, bathroom 3, and lower level back yard. The rest of the home is Off Limits. When LPA arrived, children were eating a healthy fruit snack and ready to transition to playing outside in the back yard.

LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There is no chimney or fireplace in day-care area. There are no bodies of water in the home. There are no poisons, detergents, or cleaning products accessible to day-care children. The yard area is fenced. There is a crib for each infant in care. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires in 09/2022. Licensee provides daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee has required proof of immunization and Mandated Reporter Training certificate on file.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: CHOY, RUTH H.
FACILITY NUMBER: 414004729
VISIT DATE: 09/17/2021
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At 10:15, LPA reviewed children's and helper files, and LPA observed that infants in care did not have a Safe Sleep Plan. Licensee was not aware of new Safe Sleep Regulations. A technical violation will be issued this day.
During inspection, precautions for COVID-19 were discussed. Emergency drills were discussed. Safe Sleep Plan was discussed.

*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*Licensee was given information regarding ‘Safe Sleep’ practices.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. 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 was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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