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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001123
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:32:57 AM

Document Has Been Signed on 08/24/2022 11:32 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CHEN, XIAOYUNFACILITY NUMBER:
384001123
ADMINISTRATOR:CHEN, XIAOYUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 928-1138
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Xiao Yun Chen (Angel)TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, XiaoYun Chen (Angel), and her helper. All adults had fingerprint clearance. The purpose of the inspection was explained to her. There were 8 children that included 3 infants with a helper present. LPA toured and inspected the facility for health and safety hazards. Licensee rented the one bedroom apartment on the ground level. Licensee lived in the apartment with her husband. Per licensee's request, she wanted to add the kitchen area to the daycare areas. LPA inspected the kitchen for health and safety hzards. All the kitchen lower sink cabinets and drawers were either latched or free of harmful objects. All electrical outlets were covered. The kitchen area was approved and added to the daycare areas during the inspection. The Day care areas were the entire apartment that including the living room, bedroom and the bathroom, and a kitchen. The off-limit area was the laundry area next to the kitchen, The apartment was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were made inaccessible to the daycare children. There were plenty of the age-appropriate toys, books, learning material and equipment, slide, and children's furniture that were in good condition and repair. There was a mid-size fish tank with tide lid in the living room. All electrical outlets were covered. All sharp corners were covered. Licensee installed a gate at the kitchen entrance. There were a fully charged 2A10BC fire extinguisher, working landline phone, working 2 in 1 smoke and carbon monoxide detector, and first aid supplies available in the daycare, The children's bathroom was clean and in order. All toxins and harmful objects were made inaccessible for the children. All the lower bathroom sink cabinets and drawers were latched. Per licensee, there were no children on special medication. Mat and playpen were used for napping. There were no guns and weapons in the apartment. The facility has provided Breakfast, AM/PM snacks, and lunch to the daycare children. LPA reviewed the children and staff files during the inspection. LPA also reviewed the 15 min check log during the inspection. The licensee has conducted the emergency drill with the children monthly and logged. The licensee and her helper had current CPR/First Aid training, they will expire in 2/2023 and 3/2023. The licensee and her helper had current Child Abuse Mandated Reporter Training (AB1207), they will expire in 2/2023 and 12/2022. LPA also obtained a copy of the children's roster from the facility during the inspection. All the required postings were posted by the main entrance. LPA suggested the licensee to install a mechanical chime at the main door to prevent the children leave the daycare by themselves.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
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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