414004801-6-23-2021-05-CC-CQUO-C49NLG-20210623103330

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004801
Report Date: 06/22/2021
Date Signed: 06/23/2021 10:33:35 AM

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:	HUNG, HUI LIN		FACILITY NUMBER:	414004801
ADMINISTRATOR:	HUNG, HUI LIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 208-1063
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 0	DATE:	06/22/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Hui Lin Hung		TIME COMPLETED:	11:00 AM

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Due to COVID-19 and DPH guidelines of social distancing, Licensing Program Analyst (LPA) Catrina Quimbo conducted the Pre-Licensing tele-inspection via FaceTime on June 22, 2021 at 9:00am with applicant, Hui Lin Hung. Present at the home during the tele-inspection was applicant.

The applicant has applied for a large Family Child Care Home License. Fire clearance was granted 06/15/2021. The applicant will operate from Monday to Friday from 8:00am to 6:00pm. The applicant rents and lives alone in the one-story home. The home consists of a garage, kitchen, dining room, living room, 3 bedrooms, 2 bathrooms and backyard. The DAY CARE AREAS are the dining room, living room, bedroom #2 (napping room), bathroom #2, and backyard. The OFF-LIMITS AREAS are the garage, kitchen, bedroom #1, bedroom #3, and bathroom #1. A health and safety inspection was conducted inside the home.

LPA observed the home to be clean, safe, with a working smoke and carbon monoxide detector and a fully charged fire extinguisher (2A10BC). Home does not contain stairs. The applicant has a fully stocked First Aid kit. The home has an inaccessible fireplace, barricaded by a couch. The garbage cans have tight fitting lids. The home has age appropriate toys and equipment available for children in care. The living room and bedroom#2 have soft padding and carpet installed. Applicant was reminded baby walkers, bouncers, jumpers and any other similar items are to not be used for children in care. Discipline policy was discussed.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: HUNG, HUI LIN	FACILITY NUMBER: 414004801
	VISIT DATE: 06/22/2021

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Applicant uses a designated cell phone and is aware the cell phone must stay within the home during day care hours. Per applicant, there are no firearms or weapons in the home. There are no pets in the home. All hazardous materials and toxins are kept out of reach from children. Applicant will provide breakfast, lunch and afternoon dry snacks to children in care. Food storage, sanitization and children’s allergies were discussed. Applicant will provide cribs and sleeping mats for napping children. Parents to provide sheets and blankets. Safe sleep regulations, laundering, COVID-19 guidelines and sanitization was discussed.

LPA observed the backyard to have age appropriate equipment and in good working condition. Entire backyard area is enclosed with an at least 5ft high fence. Backyard area is partially cushioned with artificial turf. There are no bodies of water in the home or additional living spaces.

Applicant is considering providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see Evaluator Manual –regulation interpretations and Procedures for the home. When any IMS is provided, an updated plan of operations for IMS will be submitted to the Department.

The applicant has proof of immunizations and completed the Mandated Reporter training on 06/02/2021. LPA informed applicant Mandated Reporter Training must be renewed every two years.

A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. Applicant was advised all assistants, volunteers, frequent visitors or adults living in the home, over the age of 18 must be fingerprint cleared, associated to the home and have proof of immunizations, prior to having any contact with the children in care. Failure to do so could result in an immediate civil penalty of $100 per person, each day.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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: HUNG, HUI LIN	FACILITY NUMBER: 414004801
	VISIT DATE: 06/22/2021

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Prior to recommended licensure, applicant must complete the following:

-Child proof knobs and/or child safety gates to off-limit areas in home including:

-Bedroom #1
-Bedroom #3
-Kitchen
-Closet located in bedroom #2
-Both alleys located on either side of home
-Floor heater vents are to be covered. Located in:
-Living Room
-Bedroom #2 (napping room)
-Proof of lead poisoning training
-Completion of EMSA certified CPR and First Aid Training

Applicant was advised to contact San Bruno Regional Office for concerns or questions. Desk Duty is available M-F, 8:00am to 5:00pm at (650) 266-8800. Forms and regulations are made available at www.cdss.ca.gov/inforesources/Community-Care-Licensing

This report is public and can be reviewed. A copy of this report will be emailed to applicant. Applicant was advised to acknowledge receipt of report once received.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC809 (FAS) - (06/04)

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