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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001763
Report Date: 11/29/2022
Date Signed: 11/29/2022 02:09:47 PM

Document Has Been Signed on 11/29/2022 02:09 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:KUNG, SHERRY LIUFACILITY NUMBER:
414001763
ADMINISTRATOR:KUNG, SHERRY LIUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 570-6966
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
11/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Sherry Liu KungTIME COMPLETED:
02:15 PM
NARRATIVE
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On November 29, 2022 at approximately 12:10pm, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, complaint visit with a case management. LPA met with licensee, Sherry Liu Kung, and explained the purpose of the inspection.

During the visit, LPA inspected day care areas for health and safety hazards. Present during the visit included licensee, licensee's assistant (A1), and 6 enrolled children.

LPA requested copies of children's records and a current children's roster. Per licensee, currently enrolled children's records and previously enrolled children's records are maintained virtually. Licensee stated children's virtual records will be provided to LPA via email by COB 11/30/2022.

LPA asked licensee of ages of children who were present during LPA's visit. Per licensee, 4 children present are about 1 year old, 1 child present is about 2 years old, and 1 child present is about 3 years old. During LPA's visit, licensee is operating over capacity with 6 children, 1 preschool age and 5 infants (under 24 months). This poses an immediate health and safety risk to children in care.

LPA reminded licensee with a large license, licensee cannot operate with more than 4 infants at a time. Licensee stated they understood.

Licensee was issued a Type A citation for operating over capacity. Please refer to 809D for more information.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided to licensee.
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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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: KUNG, SHERRY LIU
FACILITY NUMBER: 414001763
VISIT DATE: 11/29/2022
NARRATIVE
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(Page 2)

LPA Quimbo informed licensee, Sherry Liu Kung, that this report dated 11/29/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the licensee to provide a copy of this licensing report dated 11/29/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with licensee, Sherry Liu Kung.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/29/2022 02:09 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 11/29/2022 at 01:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KUNG, SHERRY LIU
FACILITY NUMBER: 414001763

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2022
Section Cited
CCR
102416.5(d)(1)

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102416.5 Staffing Ratio and Capacity (d)(1) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time...Twelve children, no more than four of whom may be infants.

This requirement is not met as evidenced by:
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Licensee will need to adjust children's schedule to meet capacity requirements of a large family child care home license that will not exceed 4 infants at any one time. LPA to conduct follow up inspection to verify correction.
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Based on observation and interview, the licensee did not comply with the section cited above. LPA observed 5 infants (under 24 months) and 1 preschool age child present in the home, which poses an immediate health, safety or personal rights risk to persons in care.
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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:Cindy Interiano
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
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