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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004500
Report Date: 11/16/2021
Date Signed: 11/16/2021 02:31:44 PM

Document Has Been Signed on 11/16/2021 02:31 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:BINSTOK, DINAFACILITY NUMBER:
384004500
ADMINISTRATOR:BINSTOK, DINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 642-0900
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Dina BinstokTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Mok met with the licensee, Dina Binstok for a prelicensing visit for the relocation today at this facility. The licensee applied for the relocation on 10/12/21. The licensee has a licensed facility in the same area. The license of the exiting daycare facility is 384004207. The applicant rents this two-story single-family house. The entire home was inspected for health and safety hazard. There were two bedrooms, 1 bath, a living room, Kitchen with adjacent dining area on the second floor. The ground level had a playroom, activity room, food preparation area, the bathroom, and the garage. The home has a working smoke detector, a working telephone, a fully charged 2A10BC fire extinguisher, first aid and emergency supplies. Day care areas are the entire ground level and backyard. The off-limit areas are the entire upper level and the garage. The daycare entrance is by the garage. Per licensee, there is no firearms or no weapons in the home. No pet in the house. All electrical outlets were covered. There were right number of cubbies available by the main entrance. Isolation area will be the hallway by the bathroom. There were plenty of the age appropriated toys and children's equipment in the day care area. Bathroom was clean and that no hazardous material is accessible to children. The licensee will prepare meals for children. LPA also discussed with the licensee about a helper who will move into the facility must have fingerprint clearance that has to be associated to the facility, completed the AB1207,and have all the required staff immunization (TB, Pertussis, Measles, and flu shot).

The following items must be completed before licensure:

· carbon monoxide detector


· remove all the unused toys and equipment from both sides of the house.
· A copy of the full rental agreement and addendum
· remove the white tall shelve or mount the shelve to the wall in the activity room.

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: Ali Zebila
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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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