Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002281
Report Date: 12/22/2015
Date Signed 12/22/2015 09:51:37 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:PUREVDORJ, TUULFACILITY NUMBER:
384002281
ADMINISTRATOR:PUREVDORJ, TUULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 513-2159
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:14CENSUS: 10DATE:
12/22/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Tuul PurevdorjTIME COMPLETED:
10:00 AM
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#2: LPA Huang met with Licensee Tuul Purevdorj for an Annual Random visit at this facility today. Purpose of the visit was explained to her. Present at the day care today were two other staff with 10 children in care, 4 of them were infants. The home was toured and inspected for health and safety hazards. Licensee rents the house. Licensee is the only person lives at this home. There is one bedroom, 1 1/2 bath, a play room, dining/Kitchen area and the backyard in this facility. The whole home except Licensee's bedroom is open for day care. Facility has a working smoke detector, a carbon monoxide detector and a working telephone. A 2A10BC fire extinguisher is fully charged. First aid supplies are available for children. Per Licensee, there is no pet, no firearms or weapons in the home. Facility conducts fire drills once every month and was properly logged There are children's toys, tables, chairs and equipment available for children in the day care area and all appeared to be safe and age appropriate. If there were ill child, Licensee would separate them in the couch by the entrance while waiting for parent to pick them up. Licensee is utilizing the children's roster and it is updated. Parents rights poster and the License are posted. Licensee has current pediatric CPR and First Aid training. Facility provides meal to children. Disciplinary policy was discussed with Licensee today. Facility records were reviewed. Facility has purchased liability insurance for her day care.

There is no deficiency cited today under CCR, Title 22, Division 12, Chapter 3:

This report and rights to comment were discussed with licensee. This report must be available in the facility for public review. Notice of site visit was posted.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2015
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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