Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002600
Report Date: 02/20/2018
Date Signed 02/20/2018 04:00:38 PM

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:YAN, MEI RONGFACILITY NUMBER:
384002600
ADMINISTRATOR:YAN, MEI RONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 278-1033
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 8DATE:
02/20/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mei Rong YanTIME COMPLETED:
04:30 PM
NARRATIVE
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2, Licensing Program Analyst, LPA Yee conducted an annual random inspection today. Present at the facility were 8 children, licensee, Mei Rong, and her mother. Licensee's helper, HuiXian is out sick today. Day-care areas is still the same as previously licensed. Areas used for day-care is on upper level which includes living room, family room, kitchen, bathroom, and backyard. The remaining areas in the home are off limit. Residents in the home are Mei Rong, and her mother only. Facility personnel summary report was reviewed with Mei and current. CPR and first aid is current until 3/6/2018. Mei Rong is scheduled to take her CPR & 1st aid class on 2/24/18. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes 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 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. Child Abuse Mandated Reporter Training was discussed. SIDS information was provided in English and Chinese.

website: ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2018
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: YAN, MEI RONG
FACILITY NUMBER: 384002600
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2018
Section Cited
HSC
1596.7995a1
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Staff Immunization:
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

** staff didn't have the proof of staff immunization's (measles, pertussis and flu) for review during inspection.**

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Licensee shall provide proof of immunization for all staff by the due date (3/19/18).
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2018
LIC809 (FAS) - (06/04)
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