Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002528
Report Date: 03/17/2016
Date Signed 03/17/2016 11:16:49 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:LUONG, NGOC KHANHFACILITY NUMBER:
384002528
ADMINISTRATOR:LUONG, NGOC KHANHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 418-4834
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:14CENSUS: 8DATE:
03/17/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ngoc Luong, Sandra MarquesTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Leung conducted an Annual visit with licensee, Ngoc Luong today. Also present were 8 children including 3 infants and 2 helpers. One of the infants is Licensee's son. LPA toured the day care area for health and safety inspection. Licensee, her husband and two children live in this flat. The following were observed during the visit: one infant was napping in a bedroom upon LPA's arrival; 7 children were playing in the play room (living room and dining room facing the front); there are cribs in the bedroom. Children's bathroom is around the corner adjacent to the kitchen. Children may use the back yard for outdoor activity. Off-limit areas are the Licensee's bedroom, bathroom next to this bedroom, daughter's bedroom, and the kitchen with dining area. Cribs and mats are available for napping. Plenty of toys and books were available in the play room. Windows have locks to prevent them to open more than 4 inches. The play room has soft padding floor. There are smoke/ carbon monoxide detectors in the house. First aid supplies are available. Fire extinguisher is charged. Gates are available to block off the hallway, the kitchen and the outside stairways. Facility prepares snacks, breakfast and lunch for children. There are no pets in the house. The back yard has outdoor toys and sand box for children. During the visit, staff took most of the children out to the neighborhood park. Helper has her current First aid/CPR training card expires in August, 2016.

This report and a Notice of Site Visit were provided to Ms. Luong.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Garfield LeungTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2016
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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