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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001763
Report Date: 12/05/2022
Date Signed: 12/05/2022 12:14:29 PM

Document Has Been Signed on 12/05/2022 12:14 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: 5DATE:
12/05/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sherry Liu KungTIME COMPLETED:
12:30 PM
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On December 5, 2022 at approximately 10:30am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, plan of correction (POC) visit. LPA met with licensee, Sherry Liu Kung, and explained the purpose of the visit. Present during LPA's visit included licensee, licensee's assistant (A1), and 5 enrolled children (1 preschool age and 4 infants).

On November 29, 2022 at approximately 12:10pm, LPA Quimbo met with licensee to conduct an unannounced, complaint visit at facility. During complaint visit, LPA observed facility to be operating over capacity with 6 enrolled children, 1 preschool age (over 24 months) and 5 infants (under 24 months). LPA issued a Type A citation for operating over licensed capacity limits. A POC was developed with licensee.

As of this date, LPA observed the licensee to be operating with 5 enrolled children, 1 preschool age (over 24 months) and 4 infants (under 24 months). Licensee stated at least one child has dis-enrolled from facility. LPA observed licensee to be operating within licensed capacity limits on this date.

LPA reminded licensee that although licensee is licensed for a large family child care home, when licensee is working alone, without any qualified assistant, licensee must operate within capacity limits of a small family child care home. Licensee stated they understood.

During today's visit, LPA observed signed and completed Acknowledgement of Receipt of Licensing Reports (LIC9224) for enrolled children. LPA observed all required licensing documents to be properly posted near front entrance of home, available for review. LPA also was able to obtain photos of currently enrolled and previously enrolled children's files.

Deficiency cited on November 29, 2022 has been cleared as of this date. LPA provided licensee copy of POC letter. No deficiencies were cited today.

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.

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: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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