384004332-12-16-2022-05-CC-NGAA-CM6QKC-20221216111406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004332
Report Date: 12/16/2022
Date Signed: 12/16/2022 11:14:16 AM

Document Has Been Signed on 12/16/2022 11:14 AM - 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:	LIU,LI XING		FACILITY NUMBER:	384004332
ADMINISTRATOR:	LIU,LI XING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 802-6130
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94134
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	12/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Liu, Li Xing		TIME COMPLETED:	11:30 AM

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 December 16, 2022 at 09:13AM, Licensing Program Analyst (LPA) Nathan Garcia arrived at the facility to conduct an unannounced Annual Inspection and met with the Licensee, Liu Li Xing. Purpose of the inspection was explained. There were no children present at the time of arrival. Licensee was outside cleaning the stairs when LPA arrived. Per Licensee, the children starts arriving around 10:00 AM. At 09:20 AM, LPA observed one child get dropped off by a parent and LPA was granted access to the home. At around 9:35 AM, another child arrived at the day care. At 9:49AM, the assistant arrived at the day care. At 10:40AM, another child arrived at the day care. Licensee was operating in compliance to the required licensed capacity and ratio limits as of today. According to the Licensee, she has a total of 5 children enrolled. LPA verified the background check clearance of the adults working or living in the home. The hours of operation are Monday through Friday, 10:00 AM 6:00 PM. Some children get dropped off earlier than 10:00 AM. Licensee provides PM snacks, lunches and early dinner which are all prepped and served at the facility. Daycare areas: Play area located downstairs and bathroom, and backyard. Off Limit areas: 2 bedrooms and 2 bathrooms located upstairs. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. LPA and Licensee inspected the entire childcare area for Health and Safety hazards. There were multiple carbon monoxide and smoke detector in the home. LPA did not perform the tests to check the functionality of the detector due to ceiling height. One fully charged fire extinguisher of size 3A40BC was also available in the home, located in the play area. First Aid kit is fully stocked and accessible. Licensee states, there are no bodies of water or weapons or guns in the home. Per Licensee, she has no pets in the home. *continue to page 2*

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

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 3

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: LIU,LI XING	FACILITY NUMBER: 384004332
	VISIT DATE: 12/16/2022

NARRATIVE

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LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation and lighting. The play area is padded and in good condition. They have a magnetic board with letters and numbers. LPA observed that there is a variety of age-appropriate toys, books, and other learning materials available in the home. There is a table for table-top activities such as puzzles or for arts and crafts. Electric outlets have built in covers and a working phone is on site. The Licensee has 'Hefferman Network Insurance' for liability insurance available.

All posting requirements are met and posted near the childcare entrance. Licensee has current and valid CPR and First Aid card expiring on 5/2/23. Licensee also has mandated reporter certificate expiring on 9/28/2023 and helper 9/29/2024. LPA reviewed facility records including Licensee's and child's files present today. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative. The facility conducts fire and earthquake drills every month, and last drill was 11/23/2022. LPA observed the backyard area with high fencing and toys are kept inside the home and brought out by the kids during outdoor play. The bicycles and sport equipments stored inside are in good repair. Per Licensee, she just got the backyard redone and plans to put padding.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record 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.

Per Licensee, the current children enrolled do not have allergies or special medications. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: www.ada.gov/childqanda.htm.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: LIU,LI XING	FACILITY NUMBER: 384004332
	VISIT DATE: 12/16/2022

NARRATIVE

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LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

LPA encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

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.

LPA discussed the safe sleep regulations with 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 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.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Liu, Li Xing.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

LIC809 (FAS) - (06/04)

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