414004773-3-17-2022-05-CC-CQUO-CCLSJL-20220317135516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004773
Report Date: 03/17/2022
Date Signed: 03/17/2022 01:55:50 PM

Document Has Been Signed on 03/17/2022 01:55 PM - It Cannot Be Edited

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: 6	DATE:	03/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Yun Zhang		TIME COMPLETED:	01:30 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 March 17, 2022 at 11:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with licensee, Yun Zhang, and explained the purpose of the inspection. Present in the home were licensee, licensee's mother, and 6 enrolled children (4 infants and 2 preschool age). Licensee is a large license and is operating within capacity limits and ratio requirements on this date. All adults living and/or working in the home have criminal record clearance on file. Hours of operation are Monday to Friday from 8:00am to 6:00pm. Licensee rents the home with licensee's mother. Home is a single level, family home that includes living room, kitchen, bathroom, 3 bedrooms, garage and backyard.The DAY CARE AREAS are the living room, bathroom, bedroom #2 and backyard. The OFF-LIMIT AREAS are the kitchen, bedroom #1 and bedroom #3. All off limit areas are properly barricaded with child safety gates and/or locked doors. At approximately 12:00pm, LPA inspected day care areas for health and safety hazards. Day care operates as a Chinese immersion program. LPA observed home to be in good repair with proper temperature and ventilation. All cleaning supplies, poisons and other chemicals were stored inaccessible to children in off limit areas. Home has a fireplace that is properly barricaded from children. There were a variety of age appropriate toys and equipment that were in good condition. Outside area does not include any pools, spas or bodies of water. The entire backyard is enclosed with an at least 5 ft. high fence. Backyard was observed to have age appropriate equipment that were in good working condition. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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: 03/17/2022

NARRATIVE

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Home is equipped with a smoke detector, carbon monoxide detector, and fully charged fire extinguisher. There was a working telephone on site. Phone number listed for licensee is current. Per licensee, there are no weapons or firearms in the home. LPA reviewed six enrolled children's records (whom were present during inspection) which were complete. Children's files have a record of emergency identification information on file. Licensee's Pediatric First Aid/ CPR certificate is current and will expire 02/2023. Licensee and licensee's mother have record of required immunizations on file. Last emergency disaster drill was conducted 02/15/2022. LPA reminded licensee to maintain and document emergency disaster drills.

During Inspection:
- Licensee was given information regarding 20-24-CCP Safe Sleep regulations and Lead Poisoning Facts Flyer.
-LPA reviewed capacity and ratios of small and large license. Licensee was reminded that when she is working alone, licensee must operate as a small license. Licensee was reminded that when operating at a Large capacity, there must be a helper present.
-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.

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: www.ada.gov/childqanda.htm.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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: 03/17/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days.

An exit interview conducted and report was reviewed with the licensee, Yun Zhang.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

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