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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004227
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:10:21 PM

Document Has Been Signed on 01/05/2022 12:10 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:KWOK, LUCY C.FACILITY NUMBER:
384004227
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
01/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lucy KwokTIME COMPLETED:
12:30 PM
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Licensing Program Analyst, LPA Yee conducted a required 1-year inspection today. The purpose of the inspection was explained. Present at the facility are licensee, her husband and 2 children. Current residents are licensee, Lucy, her husband, mom, brother, and their 3 children ages 17, 15, 12 years old. LPA reminded licensee that when her child turn 18 years old, he needs to be fingerprint cleared. She said she understands. LPA inspected the home and observed the following today. There are no pets. Per licensee, there are no guns, or weapons in the home. Daycare areas (upper level): living room/dining room, kitchen, bedroom #3 for napping only, bathroom, and backyard #1. The remaining areas of the house are off-limits. The home is equipped with a fully charged fire extinguisher, smoke alarm, and carbon monoxide detector. The home is clean and orderly. LPA did not observe baby walkers, bouncers, or jumpers in the home. The licensee has current First aid and CPR certificate which expires 9/12/23. Children's records were reviewed. The required immunization is on file. The facility personnel summary report was reviewed with the licensee and she said it's current. Children Abuse Mandated Reporter training AB1207 is on file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. The licensee AB1207 certificate has expired. The licensee said she will renew and will submit the certificate to CCL ASAP.
This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. 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. A written IMS is on file.
LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
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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