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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409152
Report Date: 07/08/2021
Date Signed: 07/08/2021 09:25:56 AM

Document Has Been Signed on 07/08/2021 09:25 AM - 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:SUNG, SYLVIAFACILITY NUMBER:
073409152
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
07/08/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Sylvia SungTIME COMPLETED:
09:45 AM
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On 07/08/21, Licensing Program Analyst (LPA), Melissa Guirit , met with applicant Sylvia Sung for an ANNOUNCED PRE LICENSING INSPECTION. Present for this inspection were applicant, fingerprint cleared husband, and applicant's two children. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 8:00 AM to 6:00 PM.

The home is a two story home . The home consists of 4 bedrooms, 3 bathrooms, living room, kitchen/dining area, back yard, and garage. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the kitchen/dining area, bedroom downstairs, entire second floor, and garage which will be inaccessible by closed and/or locked doors, safety gates and visual supervision. The ON LIMIT AREAS are the living room, downstairs bathroom, and back yard. The ISOLATION AREA will be on the couch in the living room. Outdoor play area will be the back yard which is completely fenced with 100% supervision. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 02/2023. Applicant completed the Mandated Reporter Training which expires on 02/2023.

See 809-C for continuance.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SUNG, SYLVIA
FACILITY NUMBER: 073409152
VISIT DATE: 07/08/2021
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The applicant is in compliance with new immunization law which pertains to day care providers. Per applicant, there are no firearms in the home. A copy of the deed was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. Applicant will need to complete the COVID-19 Self-Assessment and will email the completed checklist to LPA.

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .http://www.myccl.gov/

Incidental Medical Services (IMS) policy was discussed. 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: http://www.ada.gov/childqanda.htm

This home is recommended for licensing as of 07/08/21. This report shall remain on file for 3 years. Exit interview conducted with applicant.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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