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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002676
Report Date: 08/31/2022
Date Signed: 08/31/2022 03:12:30 PM

Document Has Been Signed on 08/31/2022 03:12 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LI, YUANCHENFACILITY NUMBER:
384002676
ADMINISTRATOR:LI, YUANCHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 928-3373
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Yuanchen Li, Daniel Trujillo TIME COMPLETED:
03:25 PM
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On 8/31/2022 at 11:50AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Yuanchen Li and Licensee’s Husband, Daniel Trujillo. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Present in facility was the licensee, licensee’s husband and two helpers caring for nine children (three infant age, six preschool age). Preschool age child arrived during inspection. Per licensee, mother in-law is visiting for the week. Licensee’s home is a two bedroom, one bathroom, one level apartment. Days and hours of operation are: Monday- Friday, 8:00AM. to 5:30 PM. Daycare Area: Living room (Playroom); Dining Room (Napping Area); and Bathroom #1. Off-limit Area: Hallway (Pass through only), Bedroom #1, #2 and Kitchen Area. LPA inspected home with licensee for health and safety hazards.

At 12:00PM., the following was observed: Day-care was clean, orderly, and with age appropriate playthings available for the children. Furniture, books and materials inspected were in good repair. Individual cubbies are located entry way for added storage. Facility has child sized table with chairs for snack and activities. Fireplace in playroom is properly barricaded.

At 12:10PM, Based on observations, LPA confirmed accessible window in playroom with large opening. Safety latch installed on window during inspection. Advisory Note: Technical Violation (LIC9102) was issued.

For napping services, foldable mats, playpens and crib are available for the children. LPA reminded licensee to ensure one crib was available for each infant age child in care. Infant crib inspected was equipped with tight-fitting sheet and mattress. Bathroom #1 was observed clean with adequate supplies for hand-washing. Bathroom fixtures were in operating condition. Off-limit areas of the home had been made inaccessible with child safety gates and doors. Accessible outlets and trash bins had been covered. Detergents, cleaning compounds, wipes, spray bottles, and other items (which may pose danger) were stored inaccessible to children. Facility was the proper temperature, with adequate ventilation and lighting. Home had functioning telephone; smoke detector, carbon monoxide detector; and one (fully charged) fire extinguishers (3A:40BC). Home does not have any swimming pools, spas, hot tubs, fishponds or other bodies of water. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LI, YUANCHEN
FACILITY NUMBER: 384002676
VISIT DATE: 08/31/2022
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(PAGE 2)
At 12:40PM., LPA reviewed the facility and children’s records. Children's records included the: Identification of Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Immunization Records; and signed Notification of Parent’s Rights (LIC995A).

At 12:50PM, Based on record review and interviews, LPA confirmed facility not maintaining infant napping logs with documentation of each 15- minute check. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

Staff recorded included the: Proof of Immunization; Declaration to Report Suspected Child Abuse (LIC9108); Criminal Record Statement (LIC508); and Notice of Employee Rights (LIC9052).

LPA reminded facility to ensure staff's complete the mandated reporter training (AB1207) are stored in the facility files.

Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid Certification was current, expiring 6/2024. Licensee is conducting emergency disaster drill every six months; with last drill done, 6/17/2022, properly logged.



Posted in entry way, including: Childcare License; Notification of Parent’s Rights (PUB394); and Emergency Disaster Plan (LIC610A). Children's Roster (LIC500) was reviewed during inspection. Per licensee, isolation of an ill children will be in library area.

Per licensee, facility provides lunch and snack for children in care. LPA asked licensee to ensure all children’s food containers brought to facility had been properly labeled. Per licensee, home does not have any firearms. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LI, YUANCHEN
FACILITY NUMBER: 384002676
VISIT DATE: 08/31/2022
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Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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.

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated, according to California Title 22, Health and Safety Code of Regulations. Exit interview was discussed with Licensee, Yuanchen Li, and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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