384002205-7-22-2022-05-CC-BVAN-CGKVSK-20220722164139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002205
Report Date: 07/22/2022
Date Signed: 07/22/2022 04:42:46 PM

Document Has Been Signed on 07/22/2022 04:42 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:	CHEN, XU MING		FACILITY NUMBER:	384002205
ADMINISTRATOR:	CHEN, XU MING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 566-8168
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY:	14	CENSUS: 7	DATE:	07/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Wei YuLing and ChuTong Tang; Chen Xuming		TIME COMPLETED:	05:00 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 July 22, 2022, Licensing Program Analysts (LPAs) Van and Garcia performed an unannounced mandated annual inspection and met with Licensee's helpers Wei YuLing and ChuTong Tang. Per helpers, the Licensee was out running errands. LPA explained the objective of the inspection and was granted access to the property by the helpers. Upon entering the home, the helpers asked LPAS to wait in the backyard deck for the Licensee to return. Helpers mentioned they did not know where the Licensee kept the facility records and preferred that LPAs wait until the Licensee's return to conduct the physical plants. At approximately 2:30 pm, the Licensee came home. Seven children are present today (6 preschoolers and an infant) with the two helpers. The facility complies with the licensing capacity and limits today. All adults who live or work in the house have a criminal background check. The physical plant has not changed. The off-limits and childcare areas are the same. However, during the inspection, the Licensee requested to add the current off-limit Licensee's bedroom to the daycare area. LPAs inspected the bedroom and approved it today. The Licensee's new daycare areas are the living room, children's nap room, Licensee's bedroom, previously is now called the playroom, children's bathroom, the deck, and the backyard. The off-limit areas are Licensee's children's bedrooms, the kitchen/dining area on the second floor, and the entire ground level. According to the Licensee, when a child displays indications of illness, the Licensee will separate and have the child wait in the backyard deck while contacting the parent to take them up. The days and hours of operation are Monday through Friday, 8:00 am to 5:30 pm.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: CHEN, XU MING	FACILITY NUMBER: 384002205
	VISIT DATE: 07/22/2022

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
26
27
28
29
30
31
32

LPAs examined and inspected the Licensee's indoor and outdoor play spaces for health and safety concerns. The childcare environment is clean and organized, with age-appropriate activities, books, and play materials. The home has proper heating, lighting, and ventilation and is free of defects or situations that risk children in care. The house has a fully charged fire extinguisher, smoke and carbon monoxide detectors, and a functional phone. The facility has a fully stocked first aid kit available for children. LPAs observed several playpens in a nap room. LPAs advised the Licensee that no toys, pillows, or anything else should be hung over the cribs/playpens. LPAs observed that the mattress was the right size and had a fitted sheet. A child-proof cover protects every unused electrical outlet. According to the Licensee, there were no firearms, weapons, or pets on the premises and no baby walkers, bouncers, or similar equipment in the daycare. The Licensee is informed that smoking is not permitted in family childcare facilities.

According to the Licensee, monthly fire and earthquake drills are held. The last drill took place on 7/15/2022. Breakfast, lunch, and morning and afternoon snacks are offered at the facility.

During the inspection, LPA reviewed all children's records. The Licensee maintains thorough records for all children in their care, including vaccination records and Parental Rights forms. LPA noted that each kid had a complete emergency information card that included the child's full name, phone number, and the location of a parent or authorized person who may be called in an emergency. The name and phone number of the child's doctor, as well as the parent's permission for the Licensee to consent to emergency medical care. The Licensee kept up with her immunizations, Mandated Reporter Training AB 1207, and has proper daycare liability insurance DCI. Pediatric CPR/First Aid for Licensee is valid until 2/21/2023. The Licensee posted all required paperwork, such as the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: CHEN, XU MING	FACILITY NUMBER: 384002205
	VISIT DATE: 07/22/2022

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
26
27
28
29
30
31
32

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.

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.

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.

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensees were informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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. 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. Effective July 1, 2020, Licensees must have proof of completion of EMSA certified lead poison training if applying for a change of location or capacity change to an existing license.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: CHEN, XU MING	FACILITY NUMBER: 384002205
	VISIT DATE: 07/22/2022

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
26
27
28
29
30
31
32

LPA encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

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.

The Licensee will send the following documents to San Bruno Child Care Office for the file:
-Updated Mandated Reporter Training, Facility sketch, and FCCH liability insurance.

Licensee Chen XuMing read and signed the report. During today's inspection, no deficiencies were discovered. Today's report and site visit notice will be emailed to Chen XuMing by the end of business on 7/22/2022. A receipt confirmation is necessary, and a site visit notification 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: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4