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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629260
Report Date: 06/15/2022
Date Signed: 06/15/2022 04:25:25 PM

Document Has Been Signed on 06/15/2022 04:25 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SONG, SARAH FAMILY CHILD CAREFACILITY NUMBER:
376629260
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
06/15/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Sarah SongTIME COMPLETED:
04:30 PM
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On 06/15/2022 at 3:10 PM Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Inspection for the purpose of capacity increase. LPA met with Licensee, Sara Song, disclosed the purpose of the inspection and was granted entry into the facility. Licensee's spouse was also present with 7 daycare children at the time of the inspection ages 2,3,3,3,5,5 and 5. Licensee accompanied LPA throughout the inspection of this 4 bedroom, 3 bathroom home. Applicant will use the following areas for child care: living room, bedroom 1, one bathroom, and front yard. Front yard is properly fenced and Licensee provides total supervision at all times. Off limits areas include: kitchen, laundry room, bedrooms 2-4,two bathrooms, back and side yards and garage.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  The licensee has toys, play equipment and materials available. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.  Licensee and spouse's First Aid and CPR certifications expire on 02/2024. Licensee and spouse has required immunization. Facility roster was available and updated. A total of 9 children are currently enrolled. Children's file were reviewed and found complete. The last fire and disaster drill was completed on 06/2021.



There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.  Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age.  The provider places infants up to 12 months of age on their backs for sleeping.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SONG, SARAH FAMILY CHILD CARE
FACILITY NUMBER: 376629260
VISIT DATE: 06/15/2022
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Licensee was reminded that all adults 18 and over living or working in the home, 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 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.

Incidental Medical Services (IMS) policy 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 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

No deficiencies cited.

Increase in capacity is granted effective this date.

Exit interview conducted and copy of report was provided to licensee's assistant.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC809 (FAS) - (06/04)
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