414004877-3-8-2022-05-CC-LGOZ-CCBRF6-20220308115837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004877
Report Date: 03/08/2022
Date Signed: 03/08/2022 12:00:24 PM

Document Has Been Signed on 03/08/2022 12:00 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:	WONG, TRICIA		FACILITY NUMBER:	414004877
ADMINISTRATOR:	WONG, TRICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 722-0128
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	14	CENSUS: 0	DATE:	03/08/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Tricia Wong		TIME COMPLETED:	12:15 PM

NARRATIVE

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On 3/8/2022 at 8:45A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Tricia Wong for an announced, prelicensing inspection. Purpose of inspection was explained and was for change of location. Licensee is applying for large capacity licensure. Present during inspection was the licensee. Home is a two bedroom, one bathroom, one level house. Days and hours of operations are: Monday- Friday, 8:00 A.M., to 5:00 P.M. Day-care Areas: Kitchen, Living room (Playroom), Bedroom #1, Bathroom #1 and the Outdoor Play Area. Off-limit Area: Studio unit, Garage and Drive-way. LPA inspected home, indoors and outdoors, with licensee for health and safety hazards.

At 8:50A.M., LPA observed the following: Day-care was clean, orderly and had a variety of age-appropriate toys, books and games for the children. Playthings and children’s furniture inspected were in good repair. Soft padded surface had been installed for added safety. For napping services, LPA observed several cleanable mats stored in bedroom #1. Fireplace and accessible wall heaters in the home had been barricaded. Fixtures in bathroom #1, located in hallway, was in operating condition. LPA observed all accessible electrical outlets have properly covered. Safety locks had been installed on the kitchen cabinets to prevent child access. Home had ventilation throughout. Per licensee, off-limit areas of the home will remain locked during operating hours. Home had a functioning cell phone, smoke detector and carbon monoxide and fully changed fire extinguisher (2A:10:BC), located in the facility kitchen. Per licensee, isolation of an ill child will be in the playroom. All detergents, cleaning compounds, medications and other items which could pose a danger were stored inaccessible to children. Per licensee, home does not have any no guns or weapons.

At 9:20A.M., LPA inspected Outdoor Play Area. Home does not have pools, fishponds, jacuzzis or any other bodies of water on-site. Both play areas are completely enclosed. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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: WONG, TRICIA	FACILITY NUMBER: 414004877
	VISIT DATE: 03/08/2022

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(PAGE 2)

At 9:45A.M., LPA reviewed required forms with the licensee. LPA and applicant reviewed the LIC311D, Records to Keep in Your Family Child Care Home, children’s forms/ records, facility forms, and information to be posted. Licensee’s CPR/ 1st Aid certification was current, expiring on 6/2023. Licensee’s Mandated Reporter Training certificate (AD1207) was current, expiring on 3/6/2024.

Licensee was informed that the Department must be notified prior to the use of any off-limits areas. LPA and the applicant discussed licensing regulations and the capacity requirements. Any children under 10 years of age will be counted in the capacity. Licensee was advised that all food containers brought from home must be properly stored and labelled. Licensee understands the required emergency disaster drills are to be conducted and documented every six months. Applicant understands that the use baby walkers, bouncers, jumpers and similar items are not to be used for children in care. Smoking is prohibited inside a Family Childcare Home.

Licensee 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 for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Licensee was reminded that all adults 18 years and over living or working in the home, including employee and volunteers, must obtain criminal 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 Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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: WONG, TRICIA	FACILITY NUMBER: 414004877
	VISIT DATE: 03/08/2022

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(PAGE 3)
Incidental Medical Services (IMS) 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 Americans with Disabilities Act (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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD important information website at https://www.cdss.ca.gov/infosource/community-care-licensing/subscribe and select the child care option to receive email communication.

During today's inspection licensee submitted the following items: Copy of Mandated Reporter Certification, CPR/ 1st aid Certification, Proof of Immunization and Updated Lease Agreement.

Prior to recommendation for Change of Location, licensee must complete the following:

-Finish process of moving into the home

-Post all required postings in a visible location

-Finish setup of both outdoor play area(s)

-Receive fire clearance approval (STD850)

-Obtain infant cribs for napping services

-Obtain child size table and chairs for food services

-Submit updated Application for Family Child Care Home (LIC279)

-Receive criminal record clearance for all adults in the home

-Submit an updated facility sketch with both on and off-limit areas (LIC999)

Exit interview was conducted with licensee, Tricia Wong and copy of this report was provided. This report will be kept in the facility file and made available for public review upon request. Desk Duty is available Monday through Friday between 8AM - 5PM at (650) 266 -8800.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

LIC809 (FAS) - (06/04)

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