384000808-12-12-2024-05-CC-BVAN-DBVSEQ-20241212124908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000808
Report Date: 12/12/2024
Date Signed: 12/12/2024 12:49:18 PM

Document Has Been Signed on 12/12/2024 12:49 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MOY, XIAO-SONG		FACILITY NUMBER:	384000808
ADMINISTRATOR/ DIRECTOR:	MOY, XIAO-SONG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 664-3977
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 10	DATE:	12/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:34 AM
MET WITH:	Xiao-Song Moy		TIME VISIT/ INSPECTION COMPLETED:	12:50 PM

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On December 12, 2024, Licensing Program Analyst (LPA) Van conducted an annual random inspection and met the Licensee, Xiao-Song Moy. LPA explained the purpose of the inspection to the Licensee and was given access to the home. Upon entering the house, LPA observed all the children were having arts/crafts activities. The licensee and two assistants supervised nine preschool children. The licensee complies with the licensing capacity and limits today. During the visit, another preschool child arrived. All staff members present during the inspection have had their criminal record clearance verified with the CDSS Background Check System, and they are found to have eligible clearance status on file.

According to the Licensee, there were no changes to the previously approved childcare areas. The Childcare areas are on the ground floor, consisting of a big playroom, nap room, kitchen, two bathrooms, and 1/2 of the backyard. The off-limit areas are the entire second floor, the garage, and the back half of the backyard, including the storage shed. All off-limit areas have been appropriately barricaded from the children. Days and operations are from Monday through Friday, from 7:30 am to 5:30 pm. The Licensee has valid childcare liability insurance through DC Insurance Services.

LPA and the Licensee inspected the childcare areas for any potential dangers to health and safety hazards. The childcare areas were clean and organized. The facility has age-appropriate books and activities to help children learn and play. The big playroom is divided into several pods using bookshelves. The areas also have good heating, lighting, and ventilation, and no potential hazards pose any risk to children.

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Garfield Leung	TELEPHONE: (650) 266-8800
Brendon Van	TELEPHONE: (650) 266-8800
	DATE: 12/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MOY, XIAO-SONG	FACILITY NUMBER: 384000808
	VISIT DATE: 12/12/2024

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The house has multiple combinations of carbon monoxide and smoke detectors and a fully charged fire extinguisher with a minimum standard specification of 2A 10 BC. Cleaning products and disinfectants were stored out of reach of the children. The licensee stated that no firearms or weapons were present in the home. LPA did not observe baby walkers, bouncers, or similar equipment in the childcare areas. The licensee was reminded that smoking is prohibited in the family childcare home.

The outdoor area is fully enclosed with a fence and has a climbing and sliding structure in the middle. Soft rubber cushions have been installed beneath the equipment to ensure safety and prevent accidental falls.

The licensee indicated that her program only catered to preschool-age children. However, Licensee said she knows and understands the regulations for keeping infants safe while they sleep. She knows that bedsheets must fit tightly around the mattress to prevent accidental suffocation or choking and that cribs must be free of toys, blankets, or pillows while infants are napping. Additionally, the 15-minute check and documentation are required.

LPA discussed and informed the Licensee that she must be present at home to ensure that the children in her care are always supervised. When the licensee must be absent from the house, the temporary absence should not exceed 20 percent of the hours the facility provides care per day.

During the visit, LPA reviewed the records for both children and personnel. The licensee keeps accurate records for each child, including vaccination records, parental rights forms, and complete emergency information. The licensee and her assistants have maintained records of all essential licensing requirements, such as necessary immunizations, valid Pediatric First Aid CPR certifications, and up-to-date mandated reporter training.

All the required licensing postings were observed posted. According to the licensee, regular fire and earthquake drills are conducted every other month, with the most recent drills completed on 11/22/2024.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MOY, XIAO-SONG	FACILITY NUMBER: 384000808
	VISIT DATE: 12/12/2024

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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: www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with the Licensees and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MOY, XIAO-SONG	FACILITY NUMBER: 384000808
	VISIT DATE: 12/12/2024

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LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

During the exit interview, the LICENSEE, XIAO-SONG MOY, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the licensee, Xiao-Song Moy.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC809 (FAS) - (06/04)

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