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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004338
Report Date: 04/06/2022
Date Signed: 04/06/2022 01:44:49 PM

Document Has Been Signed on 04/06/2022 01:44 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:CHULUUN,SARANFACILITY NUMBER:
384004338
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Saran ChuluunTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Saran Chuluun and her helper. All adults were fingerprinted. The purpose of the inspection was explained to her. There were 7 children that included 5 infants and 2 preschoolers with a helper present. The licensee rents a single unit on the ground level with two bedrooms, a living room, a bathroom, an open kitchen, and a side yard. The licensee lives in the unit by herself. The daycare areas are the entire unit and a side yard except bedroom #2 (Licensee's room) across the laundry room. Bedroom #1 is for napping only. The off-limit areas are bedroom #2 and the laundry room.. LPA toured the facility for health and safety hazards. There was a fully charged 2A10BC, working smoke detector, and first aid supplies available. There were plenty of age-appropriate toys, books, learning materials, a playhouse, and children's furniture available for children. All children's items were in good condition and repair. The licensee covered all electrical outlets in the daycare areas. The licensee installed the soft cushioning to the entire unit floor except bedroom #1 to prevent injury. Playpens and cribs were for napping. Boosters were for feeding only. All the kitchen drawers were free of sharp objects, and the lower sink cabinets were latched. There were no weapons and pets in the unit. The children's bathroom was clean and free of harmful objects access to the children. The lower bathroom sink cabinet was latched. The electrical outlet in the bathroom was covered. The outdoor side yard was completely fenced. There were plenty of age-appropriate outdoor toys, ride-on toys, and a playhouse available for the children. A gate was installed at the stairway to prevent children's access to the off-limit areas. The licensee provided breakfast, lunch, and AM/PM snacks to the daycare children. The licensee also had the Thermometer, hand sanitizer, disinfectant (Alcohol), face masks, and gloves available in the house to prevent COVID19. The licensee had current First Aid training and AB1207 training. The licensee has subscribed Day Care insurance that will expire in 2/2023. All required postings were posted. LPA reviewed the children and staff files during the inspection. LPA also obtained a copy of the children's roster from the licensee during inspection.

*See next page of the deficiency was cited during the inspection.*

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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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Document Has Been Signed on 04/06/2022 01:44 PM - It Cannot Be Edited


Created By: Cindy Mok On 04/06/2022 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHULUUN,SARAN
FACILITY NUMBER: 384004338

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(2)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 5 infants and 2 preschoolers which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2022
Plan of Correction
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The licensee must reduce the number of the children within capacity by the due date (4/7/2022). A follow up visit will be conducted.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Cindy Mok
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022


LIC809 (FAS) - (06/04)
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