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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004402
Report Date: 04/19/2022
Date Signed: 04/26/2022 09:35:48 AM

Document Has Been Signed on 04/26/2022 09:35 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:KAI MING MISSION BAY CHILDREN'S CENTER (PS)FACILITY NUMBER:
384004402
ADMINISTRATOR:SUSANNA LEUNGFACILITY TYPE:
850
ADDRESS:671 CHINA BASIN STREETTELEPHONE:
(415) 982-4777
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Susanna Leung, Cindy Mach, Gabriela RiveraTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Haydee Caliboso met with applicants Susanna Leung (Facility Manager/Regional Manager), Gabriela Rivera (Regional Manager) and Cindy Mach (Site Manager) today for a pre-licensing inspection. The preschool program will be part of a combination center; an infant with toddler component program at the same location. The applicant has requested 20 preschool children ages 2 to Kindergarten. The facility plans to operate Monday - Friday; 7:00AM to 6:00PM. The designated Site Supervisor for the facility will be Cindy Mach. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. This inspection included a technical assistance inspection for COVID-19 guidance and support.

Indoor: The facility building that will be used for the program is on the lower level of a residential building. The facility building has its own designated entrance. The facility has a designated “Playroom area” located in the main entrance and was calculated for 683.20 sq. ft, allowing for a capacity of 19 children. The “Playroom area” was observed to be clean and safe. There is one classroom designated for the preschool children. The Preschool classroom was calculated to be 762.20 sq. ft., allowing for a capacity of 20 preschool children. The classroom and furniture equipment are clean and in good condition. Children’s toys and supplies are orderly, in good condition, and age appropriate. There is storage space for children's personal belongings, and cots to be utilized for napping children. The program will provide a sheet and blanket for the children. Bedding is to be washed twice per week or as needed.
Cont. 809-C pg. 2
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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 4
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: KAI MING MISSION BAY CHILDREN'S CENTER (PS)
FACILITY NUMBER: 384004402
VISIT DATE: 04/19/2022
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The classroom is equipped with a fire extinguisher and both smoke and carbon monoxide detectors. The facility is adequately ventilated and free of insects and bugs. The classroom has a built-in counter-top area, sinks available for staff and children to use, and garbage cans with tight-fitting lids. The facility has a first aid kit in and a designated backpack with emergency supplies.

Refrigerated medications will be stored separately from food. Medication will be administered with parental consent and will be kept in the child’s file for record. All medication will be logged when administered to children. The facility has a designated kitchen area where food is prepared, a working refrigerator, and a working dishwasher where utensils are to be cleaned. The program will provide morning and afternoon snacks, and lunch daily.

The preschool classroom has 2 toilets and 4 sinks available for children to use. The restroom is clean and does not have any health or safety hazards. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children. The isolation area for ill children is in the Site Manager office, and staff restrooms will be used for ill children, if needed, until parents arrive for pick-up. There are 2 separate restrooms available for staff to use. Children in the program will be signed in and out daily by parents using an electronic signature. The facility will conduct and log fire drills once every six months, and the log will be available upon request. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children.

Outdoor: The outdoor area measures a total of 1,980 sq. ft., allowing for a total of 26 children. The program provided a request waiver for scheduled outdoor rotation usage. The facility’s outdoor playground is enclosed and gated with a fence approximately 10 ft. tall. The outdoor space was observed to be clean, safe, and equipped with toys that are age-appropriate for children. The outdoor space playground has pea gravel for cushion. Sandbox will be inspected daily and kept free of hazardous materials. Additionally, the program will provide water for outdoor time.
Cont. 809-C pg. 3
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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: KAI MING MISSION BAY CHILDREN'S CENTER (PS)
FACILITY NUMBER: 384004402
VISIT DATE: 04/19/2022
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Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. 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.

LPA discussed the safe sleep regulations with applicants 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 [applicant, licensee, or facility representative] 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
Cont. 809-C pg. 4
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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: KAI MING MISSION BAY CHILDREN'S CENTER (PS)
FACILITY NUMBER: 384004402
VISIT DATE: 04/19/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Susanna Leung. An electronic copy of this 4 page report was emailed to Susanna Leung. Applicant was asked to review the report and return a signed copy of the report to LPA Haydee Caliboso.

Based on available square footage, sinks, and toilets, LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 20 children. The following is required prior to licensure:

· Obtain fire clearance from SF Fire Department.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4