414004773-4-20-2021-05-CC-WLYY-C29QXZ-20210420123423

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004773
Report Date: 04/20/2021
Date Signed: 04/20/2021 12:34:38 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:	ZHANG, YUN		FACILITY NUMBER:	414004773
ADMINISTRATOR:	ZHANG, YUN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 288-5888
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 0	DATE:	04/20/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yun Zhang		TIME COMPLETED:	10:15 AM

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 Pre-Licensing tele-inspection via FaceTime on April 20, 2021 at 9:00am with applicant Yun Zhang. Present at the home during the tele-inspection was applicant and applicant's mother. Applicant rents this home. The home consists of a livingroom, kitchen, bathroom, three bedrooms, a garage and a back yard. The Day care areas are living room, bathroom and bedroom #2. Off Limit Areas are kitchen, master bedroom (bedroom #1), bedroom #3 and garage. The home also Fire Clearance from the City of San Mateo Fire Department. Per applicant, family child care’s operating hours are from Monday-Friday 8am-6:00pm. Per applicant, family child care will provide breakfast, lunch and afternoon snack. During the tele-inspection, the home is clean, safe, and has working smoke detector, carbon monoxide detector, fire extinguisher, and telephone. The Applicant 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. Applicant 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. Applicant 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. CONTINUED>>>

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021

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: ZHANG, YUN	FACILITY NUMBER: 414004773
	VISIT DATE: 04/20/2021

NARRATIVE

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Applicant is not considering providing Incidental Medical Services (IMS) to children at this time. 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

Applicant 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 Applicant. 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.

Applicant 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

At this time, applicant is recommended for licensure . A copy of this report will be emailed to applicant. Applicant was advised to acknowledge receipt of report once received.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021

LIC809 (FAS) - (06/04)

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