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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001201
Report Date: 03/08/2023
Date Signed: 03/08/2023 12:28:46 PM

Document Has Been Signed on 03/08/2023 12:28 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:CUI, PEI XIANFACILITY NUMBER:
384001201
ADMINISTRATOR:CUI, PEI XIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 468-8918
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Pei Xian Cui (Patty)TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the licensee, Pei Xian Cui (Patty), and her husband who was a helper, and explained the purpose of the inspection. All adults had fingerprint clearance. There were 6 children that included 2 infants present. Licensee owned this 2 level single family house. Licensee lived with her husband,and daughter in the house. Licensee's daughter and son have visited them sometimes during the years. Per licensee's request, she wanted to add the hallway bathroom to the daycare area. LPA inspected the bathroom. The hallway bathroom was clean. Toxins and harmful objects were made inaccessible to the children. The lower bathroom sink cabinet was free of harmful objects. The hallway bathroom was approved and added to the daycare area during the inspection. The daycare areas were living room that was used as the main playroom, bedroom next to the stairway is used for children's activity such as napping, dining room, hallway bathroom and a bathroom that was next to the dining room & a patio that was behind the kitchen. Kitchen was used as a pathway when children access to patio. The Off limit area were Licensee's bedroom, licensee’s daughter bedroom, entire lower level, and the back yard. LPA toured and inspected the facility for health and safety hazard. The house was clean and in order. All toxins and harmful objects were either locked or made inaccessible to children. Temperature and lighting were adequate. Window locks were installed to the window in the living room. There was a turtle in a mid-size fish tank with tide lid in the living room. Gates were installed at the stairway, and the kitchen entrance to prevent children access to the off-limit areas. Gates also were installed to the stairway at the deck. There were plenty of age-appropriate toys, books, learning material, and children’s furniture available for children. All sharp corners and electrical outlets were covered. Boosters were used for feeding only. There were a fully charged 2A10BC fire extinguisher, working telephone & cellular phone, working carbon monoxide and smoke detectors, and first aid supplies available in the daycare areas. The facility had installed a fire sprinkler system in the house. Children’s bathrooms were clean and free of harmful objects. There were the right size of toilets available for day care children. Play pens and cots were used for napping. Carpet was installed to the entire floor as the soft cushioning to prevent injury. The deck was completely fenced. Gates were installed to the stairway. LPA didn’t observe any harmful objects there. Licensee provides breakfast, AM/PM snacks, lunch, and dinner to the daycare children. Licensee and her helper had current CPR/First Aid training that will expire in 8/7/2024. The licensee and her husband had updated Child Abuse Mandated Reporter Training that will expire on 2/18/2025. The disaster drill has been conducted 2 times a year and logged. The latest drill was conducted in 9/2022. The facility has bought Child Care insurance that will expire in 5/2023. Per licensee, there were no children on special medication. Per licensee, she had a child who alleged curtain kinds of food, but the child did not on medication. LPA reviewed the children's file and obtained a copy of the children's roster from the licensee. LPA inspected the 15 minutes check nap log during the inspection. All postings were posted.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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