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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423619
Report Date: 03/16/2022
Date Signed: 03/16/2022 04:01:40 PM

Document Has Been Signed on 03/16/2022 04:01 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HUI, SHUI KAMFACILITY NUMBER:
013423619
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Carol WongTIME COMPLETED:
04:00 PM
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On 3/16/22 LPA Indira Loza and Licensing Program Manager Mayla Mendoza met with Licensee Shui Kam Hui for an unannounced annual inspection. The Licensee also has applied for a capacity Increase. The home and yard were inspected to conduct a health and safety check. Present during the inspection were 6 children and 3 staff with Current CPR/First Aid Certificates and Mandated Reporter certificates.. The teacher/child ratio was being met today. This center operates Monday through Friday 8 AM to 5 PM.

The Home has 2 bedrooms and 1 bathroom. The pick up and drop off area is located in the backyard. The room floors, surfaces, furniture and equipment appear to be safe, sanitary and in good repair. The furniture, equipment and activities appear to be age appropriate for the children in care. Additional play yard next door at facility #013423582 is being utilized. Licensee is reminded that no commingling of children will be allowed between both licensed facilities.The heating and lighting is adequate. LPA Loza and LPM Mendoza did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to children during todays inspection. The center provides the food and drinks to the children. LPM Mendoza and LPA Loza observed a shaded area and age appropriate toys, that appear to in good repair. All required documents are posted for public review. Disaster drills are being conducted at least once every 6 months, the last drill was recorded on 01/19/2022. The home is equipped with a working telephone, carbon monoxide detector, a pull down fire alarm near the front door, and a 2A10BC fire extinguisher next to the front door. The Licensee was granted a fire clearance on 3/10/22, to allow for a capacity of 14 children. ON LIMIT AREAS The backyard, The Living area, The bathroom and The bedroom to the left of the bathroom which is being used as a napping room, The dining room which has been converted into an infant sleeping area with 2 pack and plays OFF LIMIT AREAS are the Kitchen and the Licensee's bedroom which is located to the right of the bathroom. The Children's Roster was reviewed and a copy was obtained. A review of 6 children records and 3 staff files were reviewed. Mandated reporter training is current for all staff. All staff have been fingerprint cleared and associated to the facility. At least one opening/closing staff member has a current CPR/First Aid certificate.

The Licensee was reminded that the Facility documents are to stay in the facility. The Capacity for the facility is being approved and may serve 14 children.

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, 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 Child Care Center. 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 the 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 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 citations were given during todays inspections.



A notice of site visit was given and must remain posted for 30 days
Exit interview conducted and report was reviewed with the Licensee.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022
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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