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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004610
Report Date: 08/17/2022
Date Signed: 08/17/2022 04:43:49 PM

Document Has Been Signed on 08/17/2022 04:43 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:WU, XIU LINGFACILITY NUMBER:
384004610
ADMINISTRATOR:WU, XIU LINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 324-9002
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
08/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Wu Xiu LingTIME COMPLETED:
05:00 PM
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On August 17, 2022, Licensing Program Analyst (LPA) Van met with the Licensee, Wu Xiu Ling, for a Pre-Licensing relocation inspection. The Licensee has relocated from Facility #384004342 to this location. The purpose of the inspection was explained and granted entry to the home by the Licensee. The Licensee currently has a large license. There are eight children with Licensee and two helpers, three infants, and five preschoolers. Operation hours are Monday – Friday from 7:00 – 7:00 pm. All staff and residents have fingerprint clearance on file. Control of Property was on file. San Francisco Fire Department approved fire clearance on July 22, 2022.

Licensee and LPA inspected inside and outside the home for health and safety Hazards. The Licensee owns this single-family home, consisting of three levels with five bedrooms and three baths. The third level has two bedrooms and a bath, the second level has two bedrooms, a kitchen, and a bathroom, and the lower floor has a bedroom and a split bath. The home's residents are Licensee, her husband, mom, and a minor daughter. Childcare areas are the second level's living room, dining room, kitchen, bathroom, and roof deck. OFF limit areas are the entire third level, two bedrooms on the second level, and the lower level, including the laundry room, sauna room, backyard, and garage. LPA informed the Licensee to install baby gates to all stairs leading to the child care or off-limit areas. Home has age-appropriate toys and equipment available for children in care. The home has a working smoke and carbon monoxide detector, a working telephone, and a fully charged fire extinguisher. First Aid Kit is fully stocked and accessible. There are no pools, spas, or bodies of water on the property. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. All harmful and sharp objects are made inaccessible to children in care. The Licensee stated there are no guns, weapons, or pets in the home.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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: WU, XIU LING
FACILITY NUMBER: 384004610
VISIT DATE: 08/17/2022
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LPA reminded the Licensee to conduct an emergency drill once every six months, and log drills are required. Licensee's First Aid/CPR certificate expires in 3/2024. The front door will be the posting area. The Licensee is reminded of NO walkers, exersaucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. In addition, smoking is prohibited at the daycare.

During the inspection, the following was discussed and reviewed with the Licensee:
· 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.
· Incidentals 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: http://www.ada.gov/childqanda.htm
· The Licensee was reminded of the Department Inspection Authority. An employee or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice,
· The Licensee was given information regarding PIN 20-24-CCP Safe Sleep Regulation, PIN 20-01-CCP Required Lead Testing for Drinking Water, and Lead Poisoning Facts Flyer.
· Licensee was informed of recent PIN 21-22-CCP Local Licensing Call for Child Care Providers Regarding COVID-19.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
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: WU, XIU LING
FACILITY NUMBER: 384004610
VISIT DATE: 08/17/2022
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·The Licensee was reminded that as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.622.
· The Licensee was reminded about Mandated Reporter training available on the CCLD website. Training must be completed every two years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is unavailable in the native language, a statement can be written stating exemption until the translation is available.
· The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website.
· LPA discussed with the Licensee the self-assessment guide and provided Technical Assistance. Face coverings protocol, handwashing guidelines, hygiene, arrival procedures, and health screening were discussed.
· The Licensee was reminded for any additional questions to contact the CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.
· Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster.
· Capacity limits of a Small and Large License were discussed with Licensee. The Licensee was reminded that a Helper must be present when operating at a large capacity.

Prior to licensure, the following issues need to address.
- Install rubber corner cushions in some partitions at the roof deck
- Install baby gates or stairs on the roof deck, between lower level to second level stairs, and bottom stairs going to off-limit 3 level.
- Install Child-proof latches in the bathroom where cleaning products and disinfectants are stored.
- All electrical cords need cords hider/cover to prevent tripping hazards.

The report was reviewed and signed by the Licensee, Wu Xiu Ling. A copy of today's report was provided to the Licensee. No deficiencies are cited today under the California Code of Regulations, Title 22, Division 12.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
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