384004254-9-24-2021-05-CC-BVAN-C76VSR-20210924164157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004254
Report Date: 09/24/2021
Date Signed: 09/24/2021 05:00:23 PM

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, SHUNA		FACILITY NUMBER:	384004254
ADMINISTRATOR:	LI,SHUNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 988-5799
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94158
CAPACITY:	14	CENSUS: 6	DATE:	09/24/2021
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Li Shuna and Tony Ng		TIME COMPLETED:	04:30 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	**This is an amended report** On 9/24/2021 at 2:00 PM, an Informal Office meeting was conducted. Due to COVID-19, the meeting is done virtually, via Zoom Meeting. Present at the meeting are a Licensing Program Manager (LPM) Leung, Licensing Program Analyst (LPA) Van, Licensee's consultant, Tony Ng, and Licensee Li Shuna. Tony Ng provided Cantonese translation to the Licensee during this meeting. The purpose of this meeting is to discuss concerns regarding over-licensed infants' limitations, children's records keeping, and required Licensing postings. On 6/10/2021, the Department received a complaint alleging that the Licensee was caring for more infants than the limitation of the license, and which was determined Substantiated. Based on records reviewed and interviews, the Licensee had more than six infants in care on multiple days in the month of June and July. On several visits during the complaint investigation, the Licensee was cited for missing immunization of numerous children and failed to maintain a Children Roster. Furthermore, during a Plan of Correction visit, the Licensee failed to post the required Type A licensing reports and deficiency. Today, LPM Leung discussed the following issues with Licensee: Over infants Licensed limitation. The Amy's Daycare business name where the Licensee using the same Admission Agreement/Contract as her friend who Family Child Care Home also called Amy's Daycare. Discussed the adults that reside at the home Continued on the page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LI, SHUNA	FACILITY NUMBER: 384004254
	VISIT DATE: 09/24/2021

NARRATIVE

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The required children's record to be maintained
The Licensing reports that required posting after the inspection, especially those reports of Type A deficiency, and LIC 9224 (Parent acknowledgment of Receipt of Licensing Reports)
Discussion of safe sleep & infant sleeping plan
Discussion of proper documentation of Children Roster, especially the enrollment dates and dis-enrollment dates, need to be accurate.
The Licensee is advised that any future citations of capacity can result in further legal action.
The Licensee was informed that her facility would be visited more frequently by Licensing.

Today's report, 9/24/2021, will be sent to the Licensee email by the close of business on 9/24/21. Confirmation of receipt is required in place of a physical signature.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC809 (FAS) - (06/04)

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