384002676-1-10-2023-05-CC-LGOZ-CMXVRS-20230110154025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002676
Report Date: 01/10/2023
Date Signed: 01/10/2023 03:40:38 PM

Document Has Been Signed on 01/10/2023 03:40 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, YUANCHEN		FACILITY NUMBER:	384002676
ADMINISTRATOR:	LI, YUANCHEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 928-3373
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	01/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Yuanchen Li		TIME COMPLETED:	03:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/10/2022 at 1:10PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Yuanchen Li. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Present in facility was the licensee and helper caring for 10 children (3 infant age, 7 preschool age). Licensee's husband arrived during inspection. 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 1:20PM., the following was observed: Childcare was clean, orderly, and with age appropriate playthings available for the children. Floor and ground surfaces were clear of any hazards or obstructions. Accessible furniture and materials inspected were in good repair. Cubbies are located entry way for added storage. Playroom has child sized table with chairs for snack and activities. Fireplace in playroom is properly barricaded. For napping services, foldable mats, playpens and crib are available for the children. Licensee she has one crib was available for each infant in care. Infant crib inspected was equipped with tight-fitting sheet, visible on all sides and properly sized mattress. Bathroom #1 was observed clean with adequate supplies for hand-washing. Fixtures were in operating condition. Child safety gates and doors prevent accessed to off-limit areas. Accessible outlets and trash bins have all been covered. Detergents and cleaning compounds and other items (which may pose danger) have been stored inaccessible to children. Facility was the proper temperature, 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: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

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 4

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: 01/10/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(PAGE 2)
At 2:00PM., 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).

LPA reminded licensee to maintain required infant napping logs documenting each 15- minute review. During inspection, Advisory Note: Technical Violation (LIC9102TV) was issued.

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

Licensee’s mandated reporter training certification was current, expiring 6/19/2023.

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, 12/16/2022, 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 the library area.

Per licensee, facility provides lunches and snacks for children in care. Per licensee, home does not have any firearms.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 01/10/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(PAGE 3)
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 and report 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: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4