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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004326
Report Date: 10/18/2021
Date Signed: 10/18/2021 02:37:52 PM

Document Has Been Signed on 10/18/2021 02:37 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:XU, YINGFEIFACILITY NUMBER:
384004326
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ying Fei Xu (Amy)TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection. LPA met with the licensee, Ying Fei Xu (Amy ), her husband and her helper (Nicole) . All adults were fingerprinted. The purpose of the inspection was explained to her. There were 5 children that included 3 infants with helper present. The licensee rents a two-story apartment with two bedrooms, two baths, a living room with an adjacent dining area, and an open kitchen. The licensee lives in the apartment with her husband. Per licensee, her minor child lives with the grandparents in another location. The child doesn’t live with them at this location. The daycare areas are the entire lower lever such as a living room with adjacent dining area, bathroom, bedroom #1(which is next to the main entrance) except the kitchen area. The off-limit areas are the entire upper-level such bedrooms (#2- licensee's bedroom, bathroom), and kitchen on the lower level. The entrance from Long Bridge Street will be the main entrance of the daycare. The licensee installed a gate at the main entrance to prevent children access to the street. The childproof knob was installed at another entrance door that is connected to the building hallway. Gates were installed at the stairway to the upper level and kitchen entrance to prevent children from access. There was a working cellular phone, and at least one working carbon monoxide and smoke detector, fully charged 2A10BC fire extinguisher, emergency bag, and first aid supplies available in the apartment. The licensee also had hand sanitizer, disinfectant, and thermometer available for screening when the children arrive to prevent COVID 19. The licensee covered all electrical outlets and sharp corners in the daycare areas. There were plenty of age-appropriate toys, books, learning material, a slide structure, and children's furniture available. Soft cushioning was installed on the entire floor to prevent injury. Bedroom #1 that is next to the main entrance was clean. The licensee set up the room for young children (Toddlers or younger). All electrical outlets were covered in the room. The closet doors were latched to prevent children from access. There were some age-appropriate toys and play equipment, and books available for the children in the room. The licensee also installed the corner door hinge guard and Finger Pinch guard to the door in bedroom #1 to prevent injury.Cribs and mats will be used for napping. Per licensee, there were no children on special medication.
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 tools, please send them by email 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/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2021
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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