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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004483
Report Date: 10/13/2022
Date Signed: 10/13/2022 11:23:54 AM

Document Has Been Signed on 10/13/2022 11:23 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:LI, SUSANNA YANNAFACILITY NUMBER:
384004483
ADMINISTRATOR:LI, SUSANNA YANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 218-0633
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Susanna Yanna LiTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Yee conducted an unannounced, Required - 1-year inspection today. The purpose of the inspection was explained. Present at the facility are the licensee, Susanna, the helper, and 4 children (3 infants). The licensee is the only person that lives at the facility. The facility personnel summary report was reviewed with the licensee and she said it is current. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 8:00 am to 6:00 pm.

The licensee owns the home which is single level, a family home. DAY CARE AREAS: living room, dining room, and bathroom. The remaining areas of the house are off-limits. All off-limit areas are properly barricaded with child safety gates and/or locked doors.

LPA toured the daycare areas of the home with the Licensee. LPA observed the home to be in good repair with proper temperature and ventilation. There were a variety of age-appropriate toys and equipment in the home which were in good condition. There were no swimming pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals were stored inaccessible to children behind child-safety locked cabinets.

There was a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher that meets the fire department standard, and a working telephone on site. Per Licensee, there are no weapons or guns in the home.

LPA reviewed all 4 children's records and is in order. The staff file was reviewed and in order. The facility is operating within capacity limits.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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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, SUSANNA YANNA
FACILITY NUMBER: 384004483
VISIT DATE: 10/13/2022
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LPA reviewed Licensee's Pediatric First Aid/CPR which is current and will expire April 11, 2023. Last emergency drill was conducted on September 26, 2022. A log sheet was reviewed.

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.

This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. A Plan for Provides 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. A written IMS plan is on file.

LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff members are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. AB 1207 certificate is on file and completed on 6/29/22. The has been helper does not have AB1207 on file. The licensee said she will have the helper completed ASAP.

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 notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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