384001964-4-27-2023-05-CC-BVAN-CRAR6K-20230427124453

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001964
Report Date: 04/27/2023
Date Signed: 04/27/2023 12:45:10 PM

Document Has Been Signed on 04/27/2023 12:45 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:	CHINESE AMERICAN INTERNATIONAL SCHOOL		FACILITY NUMBER:	384001964
ADMINISTRATOR:	CHU HSI TSENG		FACILITY TYPE:	850
ADDRESS:	42 - 52 WALLER STREET		TELEPHONE:	(415) 865-6000
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	72	CENSUS: 65	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Chu Hsi Tseng		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 27, 2023., Licensing Program Analyst (LPA) Van met with Director Chu Hsi Tseng for an unannounced annual random inspection. The purpose of the inspection was explained, and the Center's security guard granted LPA entry to the facility. This facility is a preschool program. Nine teachers and the Site Director supervised 65 children at the Center. The facility operates in four classrooms, Gold, Green, Orange, and Red. The facility complies with the staff-children ratios today. The Hours of operation are Monday to Friday, 7:45 am to 6:00 pm. LPA toured and inspected the physical plant with the Director for potential health and safety hazards. The facility utilizes an electronic sign-in /out app called Brightwheel for parents or authorized representatives; sign-in/out codes are provided to the parents. LPA observed that each child has cubbies in the classroom with their names labeled. The facility is in good repair and has proper temperature and ventilation. Classrooms have age-appropriate toys and learning materials. The furniture appears steady and in good repair. The facility has a carbon monoxide & smoke detector, fully charged fire extinguishers, and working telephones. First aid supplies are fully stocked and available for children's use. All cleaning solutions, poisons, and other dangerous chemicals are inaccessible to children. Medications are stored and inaccessible to children, and all medications have proper labeling, unaltered, and parental consent. All toilets and handwashing sinks are in good working condition with proper sanitation. LPA observed no bodies of water on the premises. The facility presently has an outdoor waiver granted by the Department to use the outdoor space that allows no more than 41 preschool children at the time and the rotational schedule required. The outdoor play area is maintained clean and free of debris. Continued on page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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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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: CHINESE AMERICAN INTERNATIONAL SCHOOL	FACILITY NUMBER: 384001964
	VISIT DATE: 04/27/2023

NARRATIVE

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The outdoor play area is completely fenced, clean, and in good repair. Outdoor play structures are in good condition, and free of loose parts, and soft cushioning is underneath all play structures to absorb accidental falls. Per the Director, the sandbox is inspected twice a day. LPA reminded the Director that the staff must ensure the playground is cleared of debris or harmful material before use. An updated outdoor waiver will be reassessed with the management, and the new waiver will be sent out to reflect the current Regional Manager.
Children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Staff records indicate that all staff or individuals requiring caregiver background checks have received criminal records and child abuse index clearances or exemptions. Multiple staff members have a record of valid CPR. All staff maintained immunization records. The Director stated that the Center conducts fire and earthquakes at least once every six months; the last drill was on December 5, 2022.
The facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities). Per the Director, the Center offers only morning and afternoon snacks. Families provide lunch. Storage containers for solid waste within the Center have a proper tight-fitting cover.
Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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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: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CHINESE AMERICAN INTERNATIONAL SCHOOL	FACILITY NUMBER: 384001964
	VISIT DATE: 04/27/2023

NARRATIVE

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The Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption prior to the initial presence in a Child Care Center. 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.
The Director was informed about Mandated Reporter training. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
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 inspection, LPA requested the following document be sent to the Licensing office by May 12, 2023, to complete the annual inspection.
1. an up-to-date Emergency Disaster Plan (LIC 610)
2. Personnel Report (LIC 500)
3. Designation of Administrative Responsibility (LIC 308).
4. Incidental Medical Services Plan
5. Basic Pest Management Training completion for all staff
No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Chu Hsi Tseng. Today's report and site visit notice were provided to the Director. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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