Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002043
Report Date: 04/18/2018
Date Signed 04/18/2018 10:10:26 AM

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:FELLOM, JULIE ANNAFACILITY NUMBER:
384002043
ADMINISTRATOR:FELLOM, JULIE ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 971-4963
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:14CENSUS: 9DATE:
04/18/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Mary CurrinTIME COMPLETED:
10:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Huang met with Teacher Mary Currin for an Annual Random inspection at this facility today. Purpose of the inspection was explained to her. Licensee went out to field trip with 6 children. There were 4 children with Mary at the facility. There were also neighborhood parents with their children at the facility taking a music session with a contracted music teacher for about an hours. All children enrolled are over age of 2. The home was toured and inspected for health and safety hazards. This is a duplex, 59 & 61 Grand view St. Julie is living in 59 Grand view which has 3 floors 3 bedrooms. Licensee's partner owns this building. Current residents of the home are Licensee and her partner. Day care areas are: the play room, a small kitchen area, bathroom and the backyard on the lower level; the playroom is on the street level. The lowest level has direct access to the back yard for outdoor activity. Off limits area are: the entire top level, the storage, old kitchen, and the garage on the street level. Facility has a working smoke detector, carbon monoxide detector and one working telephone. A 2A10BC fire extinguisher is fully charged. First aid supplies are available for children. LPA observed that there were two chickens in the backyard. There are plenty of variety of children's toys, tables, chairs and equipment that are available for children in the day care area and all appeared to be safe and age appropriate for children. Licensee is utilizing the children's roster and it is updated. Licensee and staff have current pediatric CPR and First Aid training. Facility provides snacks and lunch, parents bought food for children. Disciplinary policy was discussed with licensee today. Facility records were reviewed. Incidental 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. Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. All staff and licensee have current required Immunization record. A copy of "A Child Care Provider's Guide to Safe Sleep" was provided and explained to the Licensee during the visit today. All staff have mandated reporter training in file.

There was no deficiency cited today under Title 22, Div.12 and Chapter 3.
This report and rights to appeal were discussed with Licensee and must be made available to the public upon request. LPA observed Licensee posting report and the report shall remain posted for 30 days. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2018
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 1