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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409152
Report Date: 03/15/2023
Date Signed: 03/15/2023 03:33:24 PM

Document Has Been Signed on 03/15/2023 03:33 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:SUNG, SYLVIAFACILITY NUMBER:
073409152
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/15/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:SILVIA SUNGTIME COMPLETED:
03:45 PM
NARRATIVE
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1:30PM- LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH LICENSEE SYLVIA SUNG FOR AN UNANNOUNCED INCREASE OF CAPACITY INSPECTION. LICENSEE IS REQUESTING TO INCREASE CAPACITY FROM A SMALL FAMILY CHILD CARE LICENSE TO A LARGE FAMILY CHILD CARE LICENSE . PRESENT FOR TODAY'S VISIT IS LICENSEE AND 5 CHILDREN IN CARE CONSISTING OF 2 INFANTS, 2 PRESCHOOLERS AND 1 SCHOOL AGE WHICH IS THE LICENSEE'S OWN CHILD. A FULL COMPREHENSIVE INSPECTION WAS CONDUCTED AT THIS FAMILY CHILD CARE HOME IN AUGUST 2022. DURING THAT INSPECTION, CHILDREN'S FILES WERE REVIEWED AND IT WAS DISCOVERED THAT AT LEAST 2 CHILDREN DID NOT HAVE IMMUNIZATION RECORDS IN FILE. THE FACILITY WAS CITED AND REQUIRED TO OBTAIN AND SUBMIT A COPY OF THE CHILDREN'S UP TO DATE RECORDS TO COMMUNITY CARE LICENSING AS A PLAN OF CORRECTION. LICENSEE HAS FAILED TO DO SO BY THE REQUIRED TIME. TODAY THE FILES WERE REVIEWED ONCE AGAIN TO ENSURE THE RECORDS WERE OBTAINED AND ARE UP TO DATE. PER REVIEW, IT WAS FOUND THAT THE RECORDS ARE STILL NOT IN FILE. TODAY THE FACILITY WILL BE CITED AGAIN AND A NEW PLAN OF CORRECTION DATE WITH BE SET. ONCE LICENSEE HAS COMPLIED BY OBTAINING THE RECORDS AND SUBMITTING COPIES TO COMMUNITY CARE LICENSING, THEN A LICENSE FOR A LARGE CAPACITY FAMILY CHILD CARE WILL BE ISSUED.

PER FIRE CLEARANCE; FLOOR 2 WHERE SLEEPING QUARTERS ARE LOCATED AND THE GARAGE WILL BE OFF LIMITS TO CHILDREN IN CARE

PLEASE SEE ATTACHED 809-D FOR CITATION

AN EXIT INTERVIEW WAS CONDUCTED.

A NOTICE OF CITE VISIT WAS POSTED
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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Document Has Been Signed on 03/15/2023 03:33 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 03/15/2023 at 02:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SUNG, SYLVIA
FACILITY NUMBER: 073409152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2023
Section Cited
CCR
102418(a)

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102418 Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY: A REVIEW OF RECORDS. 2 CHILDREN DO NOT HAVE IMMUNIATION RECORD IN FILE
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LICENSEE WILL HAVE THE CHILDREN'S PARENT/GUARDIAN OBTAIN THEIR CHILD'S IMMUNIZATION RECORDS AND LICENSEE WILL SUBMIT A COPY OF THE RECORS TO COMMUNITY CARE LICENSING BY 3/29/23. ONCE RECEIVED, A LARGE FAMILY CHILD CARE LICENSE WILL BE ISSUED.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023


LIC809 (FAS) - (06/04)
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